End of Life Care Flashcards

1
Q

What is palliative care?

A

palliative care is an approach that 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 and impeccable assessment and treatment of pain and other problems physical, psychosocial and spiritual

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2
Q

What defines end of life?

A
  • those likely to die within next 12 months
  • those with advanced, progressive, incurable conditions
  • general frailty
  • those at risk of dying from sudden crisis of condition
  • those with life threatening conditions caused by sudden catastrophic events
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3
Q

What are the principles of good end of life care?

A
  • open lines of communication
  • anticipating care needs and encouraging discussion
  • effective multidisciplinary team input
  • symptom control
  • preparing for death
  • providing support for relatives before and after death
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4
Q

What should be discussed as part of someones end of life care plan?

A
  • their wishes/preferences/fears
  • feelings/beliefs/values that can influence choices
  • who should be involved in decision making?
  • emergency interventions
  • preferred place of care
  • religious/spiritual/personal support
  • advance and anticipatory care plan
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5
Q

How can you formalise a patients preferences/wishes about their end of life care?

A
  • advance statement (preferences)
  • advance decision (refusals)
  • power of attorney (allowing someone else to make medical decisions)
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6
Q

Things to consider in assessing the validity of an advance decision

A
  • is it clearly applicable?
  • when was it made?
  • did the patient have capacity when it was made?
  • were they coerced into making it?
  • has the decision been withdrawn?
  • are there more recent actions/decisions inconsistent?
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7
Q

What are the benefits of advance statements/decisions?

A
  • enhances autonomy
  • can improve discussions on end-of-life decisions
  • avoid breaching patient’s personal/beliefs
  • death with dignity
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8
Q

What are the disadvantages of advance statements/decisions?

A
  • may not be valid
  • may not be applicable
  • attitudes may change with onset of serious illness
  • may have been advances in medicine since being made
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9
Q

What are the 5 priorities of care of dying people?

A
  • possibility that a person may die within next few days/hours recognised and communicated clearly, decisions made and actions taken in accordance with the person’s needs and wishes, which are regularly reviewed
  • sensitive communication between staff and dying person and their close ones
  • dying person and close people are involved in decisions about treatment to the extent that the dying person wants
  • needs of close ones identified as important to the dying person actively explores, respected and met as far as possible
  • an individual care plan including food, drink, symptom control, psychological/social/spiritual support is agreed, coordinated and delivered with compassion
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10
Q

Recognition of death

A
  • observe and confirmed for minimum of 5 minutes
  • apnoea; no breath sounds

after 5 minutes:

  • absence of pupillary responses to light
  • absence of corneal reflexes
  • absence of any motor response to supra-orbital pressure
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11
Q

Confirmation of death

A

in primary care:

  • absence of central pulse
  • absence of heart sounds

in secondary care:

  • asystole on a continuous ECG
  • absence of pulsatile flow using direct intra-arterial pressure monitoring
  • absence of contractile activity using echo
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