End of Life Care Flashcards
How do we assess a patient at end of life?
Level of function
WHO PS = in oncology
= 0(fit + well) - 5 (dead)
Karnofsky scale = assess mobility + cognitive function
= 100 (well) - 0 (dead)
Treat patient according to level of function
What does the medium category of Karnofsky scale mean?
Only 10% of patients with score of 50% or below will survive over 6 months
Describe the Stable Phase of the phases of illness
Phase I
Patient problems + symptoms are adequately controlled by established plan of care
+ further interventions planned to maintain symptom control + QoL
+ family/carer situation is relatively stable + no new issues are apparent
Describe the Unstable Phase of the phases of illness
Phase II
An urgent change in the plan of care or emergency treatment is required because
= patient experiences a new problem that was NOT anticipated in existing plan of care
+ patient experiences a rapid increase in severity of current problem
+ family/carers experience changes which impact on patient care - eg. partner unwell = currently can’t care for them
Describe the Deteriorating Phase of the phases of illness
Phase III
Care plan is addressing anticipated needs BUT require periodic reviews because
= patient’s overall function is declining
+ patient experiences an anticipated + gradual worsening of existing problem
+ family experience gradual worsening distress that is anticipated
Describe the Dying Phase of the phases of illness
Phase IV
Death is likely within days
Describe the illness of trajectory of cancer
Stable then declines
Once starts to deteriorate most likely won’t get better
Often a few years, BUT decline usually over few months
Describe illness trajectory of heart + lung failure
Naturally declines
Have quick deteriorations BUT then get better
Normally 2-5 years BUT death usually seems sudden
Describe the illness trajectory of dementia
Function low to begin with + slowly deteriorates
Why is it important to review medication in palliative care?
Needs to be reviewing + stopping medication that aren’t beneficial
BUT needs to be done one at a time = if stopped ALL + something went wrong wouldn’t know which
Deprescribing = planned, prioritise one, monitor + supervise
eg. statins
What is also used to determine what medicines can be stopped?
Remaining life expectancy
Time until benefit
Goals of care = what does the patient want
Treatment target = eg. BP 140/90 BUT this is not individual to the patient
Why do you need to decrease dose by 30% when switching opioids?
Become tolerant to one
= BUT switch = incomplete cross-tolerance
= don’t want to overdose patient
How do you know when to start the infusion of a new opioid?
Based on Tmax of the drug
Describe the end of life medications
Analgesia = pain = morphine
Anxiolytic = sedative = diazepam
Antiemetic = N+V = haloperidol/metoclopramide
Anticholinergic = hyoscine = prevent any respiratory secretions
How much is used in a 20ml syringe driver?
17ml
Need to know these values as this will be total volume
How much is used in a 30ml syringe driver?
23ml
Need to know these values as this will be total volume
What can be problem with syringe drivers?
Phenytoin = acid drug
= put in basic diluent
= increase ionisation
Drug needs to be compatible
