End of Life Flashcards

1
Q

Define palliative care

A

It is the approach that improves quality of life of patients and families facing issue with life-threatening illness via prevention and relief of suffering by early identification, impeccable assessment and treatment of relief and other problems, physical, psychosocial and spiritual.

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2
Q

Define end of life

A
  • Likely to die in next 12 months,
  • Advanced progressive, incurable conditions,
  • risk of dying from sudden crisis of condition or,
  • life threatening conditions caused by trauma.
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3
Q

What are the principles of good end of life care?

A
  • Open lines of communication,
  • Anticipating care needs and encouraging discussion
  • Effective multidisciplinary team input,
  • symptom control,
  • preparing for death,
  • providing support for relative before and after death.
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4
Q

What are the two types of palliative care given?

A

Generalised - \integral part of care delivered by all health care professionals.

Specialised - (consultants) deals with more complex palliative care needs

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5
Q

Name members of the multidisciplinary team

A

Specialised nurses, palliative care docs, GPs, secondary care docs, district nurses, OTs, dieticians, physiotherapists and counsellors etc.

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6
Q

What is the importance of psycho-spiritual distress?

A

It can exacerbates physical symptoms

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7
Q

What is advance and anticipatory care planning?

A

Ongoing process of discussion between the patient, those close to them and their care providers focusing on patients wishes.

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8
Q

What should be discussing palliative care?

A
  • Wishes and preferences,
  • Feelings/beliefs/ values,
  • who should be involved in making decisions,
  • Emergency interventions,
  • Preferred place of care
  • religious or spiritual,
  • ## Need of advance and anticipatory care plan?
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9
Q

What is the difference between advance statement and advance decision?

A

Statement - What care you do want to receive.

Decision/directive - What treatment you do not want to recieve.

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10
Q

In more detail, explain advance statement?

A
  • Setting down preferences, wishes, beliefs and values regarding future care.
  • Provides guidance if patient loses capacity.
  • Future decisions can’t be bound by their statement and,
  • Treatment must be of overall benefit to patient.
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11
Q

In more detail, explain advance decision?

A
  • Decision to refuse specific type of treatment at some point in future.
  • Validity and applicability need to be concerned.
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12
Q

How do you know if an advance decision is valid?

A
  • Is it clearly applicable?
  • When was it made?
  • Did the patient have capacity at the time?
  • Was it an informed decision?
  • Were there any undue influences made?
  • Has the decision been withdrawn?
  • Are more recent actions inconsistent?
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13
Q

What are the pros and cons of advance statements and decisions?

A

Pros - enhances autonomy, improve end of life decisions, avoid breaching patients personal beliefs and death with dignity.

Cons - may not be valid, not applicable, may change, may be advances in medicine since being made.

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14
Q

What are the principles for care in the last days and hours of life?

A

1) Informative, timely and sensitive communication is essential.
2) Decisions about person’s care made on muilti-disciplinary discussion.
3) Individual physical, psychological, social and spiritual needs recognised.
4) Consideration to wellbeing of relatives.

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15
Q

What is the recognition of death?

A

The simultaneous and irreversible onset of apnoea and unconsciousness in the absence of circulation. For 5 mins.

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16
Q

Recognition of death in primary care?

A
  • Absence of mechanical cardiac function by absence of central pulse and heart sounds.
17
Q

Recognition of death in hospital?

A
  • Asystole in ECG,
  • Absence of pulsatile flow using intra-arterial pressure monitoring,
  • Absence of contractile activity using echo.
18
Q

What must there be after 5 mins of continued cardiorespiratory arrest to confirm death?

A
  • Absence of pupillary response to light,
  • Absence of corneal reflexes and,
  • Absence of any motor response to supra-orbital pressure.