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MD3001 > end of life and patients > Flashcards

end of life and patients Flashcards

1
Q

define palliative care

A 
improves the quality of
life of patients and their families facing the problem
associated with life-threatening illness
through the prevention and relief of suffering by
means of early identification 
 impeccable assessment
 treatment of pain and other problems, 
 physical, psychosocial and spiritual
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2
Q

what are the principles of end of life care

A

• Open lines of communication
• Anticipating care needs and encouraging discussion
• Effective multidisciplinary team input
• Symptom control – physical and psycho-spiritual
• Preparing for death - patient & family
• Providing support for relatives both before and after
death
early identification

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3
Q

what should be discussed in advanced care planning

A

Wishes / preferences / fears about care
• Feelings/ beliefs / values that may influence future
choices
• Who should be involved in decision making?
• Emergency interventions e.g. CPR
• Preferred place of care
• Religious / spiritual / other personal support
• May wish to make an Advance & Anticipatory care plan /
formalise wishes regarding care

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4
Q

types of formal wishes

A

advance statement
advance refusal
power of attorney

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5
Q

how do you asses the validity of advanced decisions

A
  • Is it clearly applicable?
  • When was it made?
  • Did the patient have capacity when it was made?
  • Was it an informed decision?
  • Were there any undue influences when made?
  • Has the decision been withdrawn?
  • Are more recent actions / decisions inconsistent?
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6
Q

what is empathy

A

understanding another person’s feeling

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7
Q

what is sympathy

A

being affected, entering or sharing the feelings of another, compassion and commiseration

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8
Q

what 4 areas of care must always be maintained

A

must act in accordance with legislation
must not be unfair
must not deny access to services
must not cause patients distress

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9
Q

what 3 areas does the BMA support conscientious objection?

A

abortion (abortion act)
fertility treatment ( human fertilisation and embryology act )
withdrawl of life sustaining treatment

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10
Q

describe Janaway case

A

secretary refused to write abortion letters

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11
Q

describe eweida and others

A

british airways refused to let employee wear a cross

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12
Q

what limitations are placed on religious freedoms

A

prescribed by law and are necessary in a democratic society in the interests of public
safety, for the protection of public order, health or morals, or the protection of the rights and freedoms of others.

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13
Q

what are the 4 arguments against conscientious objection

A

inefficiency and inequality
inconsistency
commitments of a doctor
discrimination

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14
Q

what are some of the complications of iV drug admin

A 
phlebitis
infection 
thrombosis
extravasation
anaphylaxis
overdose
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15
Q

what is red man syndrome

A

hypersensitivity to vancomycin

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16
Q

how does first order kinetics apply to drug elimination

A

the amount of drug eliminated per unit time is proportional to the conc of drug in the plasma

plasma conc will tend towards a plateau or equilibrium

input = output

Css

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17
Q

what is clearance

A

the volume of blood cleared of drug in a unit time

it is a CONSTANT

but amount of drug eliminated per unit time varies, hence graph slopes down

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18
Q

Css=

A

rate of drug administered (Ko) / Clearance

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19
Q

what determines the time taken to reach Css

A

elimination half life (t 1/2)

Css depends on the rate of drug in and the rate of clearance

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20
Q

what is the half life dependant on

A

volume of distribution and clearance

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21
Q

what is health promotion

A

the process of enabling people to increase control over and to improve their health

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22
Q

what are the methods of health promotion

A 
provide information
enhance motivation
behavioural methods
health behaviour maintainance and relapse prevention
combined programmes
CBT
motivational interviewing
gain vs loss
training, reminding, reinforcing
slimming clubs
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23
Q

what is an example of primary prevention

A

walking campaign HEBS

24
Q

describe the stage model

A 
pre contemplation
contemplation
preparation
action 
maintenance 
relapse
25
Q

describe secondary prevention

A

blood pressure and cholesterol checks
behavioural counselling

used for people with one or more modifiable cv risk factors

26
Q

describe a type a personality

A

high competitiveness
high hostility
high time urgency

27
Q

how is type a personality reduced

A

stress reduction
relaxation
anger management

28
Q

what are some barriers to exercise

A 
bad weather
too tired
don't know how
fear
time
29
Q

what does smart stand for

A 
specific
measurable 
achievable
realistic
time based
30
Q

how long is the warm up in cardiac rehab

A

15 minutes

31
Q

how long is the conditioning phase

A

20 minutes
circuits used
comfortably short of breath

32
Q

what does FITT stand for

A

frequency
intensity
time
type

33
Q

how long is the cool down

A

10 minutes

34
Q

what shapes our experience of illness according to the biopsychosocial model

A

biology eg genetics
psychology eg beliefs, behaviour and emotion
social eg culture, deprivation and support

35
Q

why are psychological factors important in heart disease

A 
impact disease process
may impact treatment adherence
prolongs stress
poor QOL
fear 
loss of control 
denial 
anger
 illness behaviour
cognitive function
36
Q

describe SF 36 QOL measurement

A
  1. Physical functioning
  2. Physical role
    functioning
  3. Bodily pain
  4. General health
  5. Vitality
  6. Social role functioning
  7. Emotional role
    functioning
  8. Mental health
37
Q

what are the symptoms of depression

A 
changes in sleep
diurnal variation
change in appetite
less activity
less concentration
38
Q

what is HADS- Hospital Anxiety and Depression Scale

A

self report assessment of anxiety and depression

39
Q

what is erectile dysfunction a marker of

A

CVD

40
Q

describe the chain of infection

A 
infectious agent 
reservoir 
portal of exit
mode of transmission 
portal of entry
susceptible host
41
Q

what are the three modes of transmission

A

droplet
contact
airborne

42
Q

what are standard precautions

A

should be taken with every patient

43
Q

what are transmission based precautions

A

supplement standard precautions

patients with a pathogen or suspected pathogen

44
Q

name some antibiotic resistant organisms

A

GRAM +VE
MRSA
VRE

GRAM -VE
ESBL producing enterobacteriaceae
carbapenase producing enterobacteriaceae (CPE)
carbapenase producing psuedomonas

45
Q

how many years of life does the average smoker lose

A

7.5

46
Q

what are the 5 As of smoking cessasion

A 
ask 
advise
assess
assist
arrange follow up
47
Q

what are the features of advice

A

clear
strong
personalised

48
Q

what is the feature of assess

A

what is the patients willingness to quit in the next 30 days

49
Q

what are the 5 Rs

A 
relevance
risks 
rewards
roadblocks
repepition
50
Q

is case control study retrospective or prospective

A

retrospective

looks at a group of interest and a control group and looks back at exposures

selection of a control group is difficult and may be confounders

eg cancer patients

51
Q

what is a cohort study

A

take a group and a control group, follow over time and compare outcomes

eg smokers vs non smokers

52
Q

what is a crossover design

A

each subject received both the intervention and control separately and randomly

53
Q

what are the Bradford hill criteria linking smoking to lung cancer

A 
strength of association
dose response 
temporality
consistency
biological plausibility
reversibility
54
Q

what are some of the health hazards of being in hospital

A 
HAI infections
bed rest
stressful hospital environment
loss of control 
depersonalisation
55
Q

what are some negative effects on children in hospital

A

separation anxiety

misconceptions about illness

MD3001 (33 decks)

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