End Of Life Care Flashcards
What are some physical clues?
Profoundly weak Gaunt Drowsy Disorientated Diminished oral intake Difficulty taking oral medication Poor concentration Abnormal breathing patterns Skin colour changes Temperature changes at extremities
What are the 5 priorities of care?
Recognition that a person may die
Communication - sensitive
Involvement - patient and their significant others involved in any decision about treatment and care
Support - needs of family and sig others explored, respected and met as far as possible
Plan and do - individualised care plans implemented
End of life care pathways include…
Psychological needs Spiritual and religious needs On going symptom management Resuscitation Anticipatory prescribing Good after death care
What does CANH stand for?
Critically assessed nutrition and hydration
What principles should be followed with regards to pharmacological interventions?
Aim for comfort and dignity Minimise side effects After discussion, discontinue medications that are not contributing to symptom benefit Discuss most effective route Titrate according to need/ PRN use
What is one of the main concerns of patients and families at end of life?
Symptom management
What is anticipatory prescribing needed for?
Pain Breathlessness Nausea and vomiting Anxiety/ delirium/ agitation Respiratory secretions
What should be prescribed for pain (if opioid naive)?
2.5-5mg S/C PRN or equivalent to oral PRN
What should be prescribed for dyspnoea?
Midazolam 2.5-5mg s/c PRN
Morphine 2.5-5mg s/c PRN
What should be prescribed for secretions?
Glycopyrronium 200mcg s/c PRN
What should be prescribed for sedation?
Midazolam 2.5-5mg s/c PRN
Levomepromazine 6.25-12.5 mg s/c PRN
What should be prescribed for nausea?
Levomepromazine 2.5-6.25mg s/c PRN
Who should be referred?
Complex symptoms
Psychological support for patients and relatives
Advice with regards to medications
Assessment for transfer to local hospice or home
