End of life care Flashcards
what are principles of ‘a good death’?
mantaining dignity and privacy
to retain a degree of choice and control
have an understanding of what to expect
adequate relief from pain and other symptoms
respect wishes: advance care planing
die naturally
what is advance care planning?
a process which may include:
values, beliefs and wishes
preferences about care, treatment and information
anything the patient would wish to avoid happening to them
communication and consultation with others
organising affair
what is an advance decision to refuse treatment?
specifies specific interventions they would like to avoid happening to them in certain circumstances
what can help you recognize when someone is dying?
the disease trajectory disease extent biomarkers ie albumin response to treatment rate of change patients perception
what features tend to be part of the ‘last days of life’?
profound weakness
diminished intake of food and fluid
difficulty swallowing medications
drowsiness
what should doctors do when a patient is actively dying?
- recognise the patient may die
- communicate clearly
- make decisions in accordance with the persons needs and wishes involving the patient and those close to them
- regularly review interventions and revise decisions
- ensure the needs of those close to the patient are explored, respected and met
- an individual plan of care including food and drink, symptom control, support is agreed
what are common symptoms when people are actively dying?
pain breathlessness restlessness confusion nausea and vomiting noisy breathing urinary incontinence constipation dry mouth
what can be given for restlessness and agitation?
haloperidol oral
terminal phase: S/C midazolam
what are good anti emetics for end of life care?
cyclozine
metoclopramide
chemo induced nausea: idanzotron
raised ICP nausea:
Cyclozine
Metoclopramide: good for nausea due to gastric stasis
what can be given for increased respiratory secretions?
carbocysteine
