End of Life

Question 1

State 5 signs of the terminal phase

Answer 1

• Increased fatigue without apparent cause
• Express a realisation that they’re dying
• Reduced Cognition
• Peripherally cyanosed
• Apnoea/altered breathing

Question 2

What are the five priorities of care?

Answer 2

• Recognition (recognised, communicated and decisions are in line with wishes)
• Communication (Sensitive)
• Involvement (of patient and SO)
• Support (inc needs of families and SOs)
• Plan and Do (individualised care plan implemented)

Question 3

How should Food and Drink be managed in EoL care?

Answer 3

Supported to eat and drink as long as they wish to do so

Discuss aspiration risk

Can be a very emotive concern

Question 4

What is CANH?

Answer 4

Clinically Assisted Nutrition and Hydration

Regarded as a medical treatment

Only given if of benefit to the patient

Question 5

How should Hydration be managed?

Answer 5

Offer good mouth care and assess daily

Consider CAH

Question 6

Give a risk and benefit to CAH

Answer 6

Benefit: Relieves symptoms secondary to dehydration

Risk: Can cause other complications

Important to share uncertainty if it prolongs life or extends dying process

Question 7

How should pharmacological interventions be managed?

Answer 7

Aim for comfort and dignity
Discontinue meds not contributing to overall benefit
Discuss most effective route
Titrate according to PRN

Question 8

What should be the anticipatory prescribing for Pain?

Answer 8

Morphine 2.5-5mg S/C PRN

Question 9

What should be the anticipatory prescribing for Dyspnoea?

Answer 9

Midazolam 2.5-5mg s/c PRN

Morphine 2.5-5mg s/c PRN

Question 10

What should be the anticipatory prescribing for Secretions?

Answer 10

Glycopyrronium 200mcg S/c PRN

Question 11

What should be the anticipatory prescribing for Agitation?

Answer 11

Midazolam
Haloperidol
Levomepromazine

Question 12

What should be the anticipatory prescribing for Nausea?

Answer 12

Haloperidol

Levomepromazine

Question 13

State the five principles of the Mental Capacity Act

Answer 13

Presume Capacity
Indivuduals supported to make their own decisions
Unwise decisions do not mean lack of capacity
Use Best Interests approach
Use the least restrictive option

Question 14

How should you act if your patient is deemed to not have capacity?

Answer 14

Best interest decisions based on likely outcome of clinical intervention and knowledge about what patient would’ve wanted
The family can be consulted but cannot make decision

Question 15

What is an Advanced Directive?

Answer 15

A legal document that contains specificities of how you want decisions to be made about you if you cannot make them yourself

Question 16

What is a Power of Attorney?

Answer 16

Legal document that names one person the healthcare agent of another person

Question 17

What is a Respect Form

Answer 17

Recommended Summary Plan of Emergency Care and Treatment

Creates a summary of personalised recommendations for when they’re unable to express choices

Question 18

What are the sections of a Respect form?

Answer 18

Patient details
Info about person and their health
Preferences for care
Clinical recommendations for care
CPR decisions
Decisions about capacity 
Clinician details
Emergency contact details

Question 19

How should you manage a patient that wishes to have CPR inappropriately?

Answer 19

Make sure they have full information on likely survival and level of recovery
Not obliged to give treatment