end of life and patients Flashcards
define palliative care
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
what are the principles of end of life care
• 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
what should be discussed in advanced care planning
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
types of formal wishes
advance statement
advance refusal
power of attorney
how do you asses the validity of advanced decisions
- 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- Has the decision been withdrawn?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?
what is empathy
understanding another person’s feeling
what is sympathy
being affected, entering or sharing the feelings of another, compassion and commiseration
what 4 areas of care must always be maintained
must act in accordance with legislation
must not be unfair
must not deny access to services
must not cause patients distress
what 3 areas does the BMA support conscientious objection?
abortion (abortion act)
fertility treatment ( human fertilisation and embryology act )
withdrawl of life sustaining treatment
describe Janaway case
secretary refused to write abortion letters
describe eweida and others
british airways refused to let employee wear a cross
what limitations are placed on religious freedoms
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.
what are the 4 arguments against conscientious objection
inefficiency and inequality
inconsistency
commitments of a doctor
discrimination
what are some of the complications of iV drug admin
phlebitis infection thrombosis extravasation anaphylaxis overdose
what is red man syndrome
hypersensitivity to vancomycin
how does first order kinetics apply to drug elimination
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
what is clearance
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
Css=
rate of drug administered (Ko) / Clearance
what determines the time taken to reach Css
elimination half life (t 1/2)
Css depends on the rate of drug in and the rate of clearance
what is the half life dependant on
volume of distribution and clearance
what is health promotion
the process of enabling people to increase control over and to improve their health
what are the methods of health promotion
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
what is an example of primary prevention
walking campaign HEBS
describe the stage model
pre contemplation contemplation preparation action maintenance relapse
describe secondary prevention
blood pressure and cholesterol checks
behavioural counselling
used for people with one or more modifiable cv risk factors
describe a type a personality
high competitiveness
high hostility
high time urgency
how is type a personality reduced
stress reduction
relaxation
anger management
what are some barriers to exercise
bad weather too tired don't know how fear time
what does smart stand for
specific measurable achievable realistic time based
how long is the warm up in cardiac rehab
15 minutes
how long is the conditioning phase
20 minutes
circuits used
comfortably short of breath
what does FITT stand for
frequency
intensity
time
type
how long is the cool down
10 minutes
what shapes our experience of illness according to the biopsychosocial model
biology eg genetics
psychology eg beliefs, behaviour and emotion
social eg culture, deprivation and support
why are psychological factors important in heart disease
impact disease process may impact treatment adherence prolongs stress poor QOL fear loss of control denial anger illness behaviour cognitive function
describe SF 36 QOL measurement
- Physical functioning
- Physical role
functioning - Bodily pain
- General health
- Vitality
- Social role functioning
- Emotional role
functioning - Mental health
what are the symptoms of depression
changes in sleep diurnal variation change in appetite less activity less concentration
what is HADS- Hospital Anxiety and Depression Scale
self report assessment of anxiety and depression
what is erectile dysfunction a marker of
CVD
describe the chain of infection
infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host
what are the three modes of transmission
droplet
contact
airborne
what are standard precautions
should be taken with every patient
what are transmission based precautions
supplement standard precautions
patients with a pathogen or suspected pathogen
name some antibiotic resistant organisms
GRAM +VE
MRSA
VRE
GRAM -VE
ESBL producing enterobacteriaceae
carbapenase producing enterobacteriaceae (CPE)
carbapenase producing psuedomonas
how many years of life does the average smoker lose
7.5
what are the 5 As of smoking cessasion
ask advise assess assist arrange follow up
what are the features of advice
clear
strong
personalised
what is the feature of assess
what is the patients willingness to quit in the next 30 days
what are the 5 Rs
relevance risks rewards roadblocks repepition
is case control study retrospective or prospective
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
what is a cohort study
take a group and a control group, follow over time and compare outcomes
eg smokers vs non smokers
what is a crossover design
each subject received both the intervention and control separately and randomly
what are the Bradford hill criteria linking smoking to lung cancer
strength of association dose response temporality consistency biological plausibility reversibility
what are some of the health hazards of being in hospital
HAI infections bed rest stressful hospital environment loss of control depersonalisation
what are some negative effects on children in hospital
separation anxiety
misconceptions about illness
