End of life care Flashcards
What are common signs someone is dying?
Weakness, gaunt appearance, drowsiness, disorientation, diminished oral intake, poor concentration, skin colour changes, temp changes at extremities
These are not exclusive to death
What is the most important sign that a patient is dying
A condition which means death is likely, such as end stage geart failure/metastatic cancer
What is the focus of medical treatment for the dying?
Managing the symptoms and balancing medications
What are some of the symptoms of dying?
ie we need to medically manage
Pain, breathlessness, agitation, secretions (vomit, fits, seizures, bleeds, urinary incontinence/retention
What is the doctrine of double effect
If doing something morally good has a morally bad side-effect it is ethically OK to do it providing the bad side-effect was not intended. This is true even if you foresaw that the bad effect would probably happen.
What factors are essetntial in symptom control being balanced with medication management
Non-oral, anticipation of problems, stop medication not helping symptoms
What drugs are used to aid pain at the end of life
Opioids (diamorphine, morphine, oxycodone, fentanyl)
What treatments are used to treat breathlessness at the end of life?
Oxygen, opioids, benzodiazepenes
How is agitation treated
Exclude causes like UTI/retention, treated in a calm atmosphere with a light. Failiar faces allow re-orientation, setation only if necessary
What drugs are used for agitation
Midazolam is a sedative, haloperidol is an antipsychotic
Levomepromazine is also used
WHat is the death rattle
Normal secretions dying patient is too weak to clear cause a noisy, rattly wet breathing noise
Often patient does not hear it so no treatment needed as not distressing
How can secretions be treated to undo death rattle
Positional change, suction, drugs (hyoscine butylbromide or hydrobromide
What are syringe drivers
Device for delivering steady infusions, usually subcutaneous in palliative care
