end of life/continuity of care

Question 1

Discuss 4 ways gp involved in health care journey of patient with life limiting disease other than end of life symptom management

Answer 1

Multiplr stages of patients journey. Initial diagnosis, managing symptoms, treatment

Question 2

What is the end of life?

Answer 2

People are ‘approaching the end of life’ when

they are likely to die within the next 12 months

Question 3

what is palliative care WHO definition

Answer 3

“Palliative care is an approach that improves the quality
of life of patients and their families facing the problems
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.”

Question 4

frequency Specific Symptoms in

the Last 48 hours of Life

Answer 4

Noisy and moist breathing 56
• Urinary dysfunction - Incontinence 53
• Retention 21
• Pain 51
• Restlessness and agitation 42
• Dyspnoea 22
• Nausea / vomiting 14
• Sweating 14
• Jerking, twitching, plucking 12
• Confusion  9

Question 5

difference between health care and social care?

Answer 5

• Health care is associated with the treatment,
care or aftercare of someone with a disease,
illness, injury or disability.

Social care relates to the assistance of daily
living – maintaining independence, social
interaction and supported accommodation
such as a care home.

Question 6

patient choices where to die

Answer 6

hospital
nurisng home
hospice
home

Question 7

The 5 priorities:
The Priorities for Care are that, when it is
thought that a person may die within the next
few days or hours..

Answer 7

1. this possibility is recognised and communicated clearly, decisions made and actions
   taken in accordance with the person’s needs and wishes, and these are regularly
   reviewed and decisions revised accordingly.
2. Sensitive communication takes place between staff and the dying person, and those
   identified as important to them.
3. the dying person, and those identified as important to them, are involved in
   decisions about treatment and care to the extent that the dying person wants.
4. the needs of families and others identified as important to the dying person are
   actively explored, respected and met as far as possible.
5. an individual plan of care, which includes food and drink, symptom control and
   psychological, social and spiritual support, is agreed, co-ordinated and delivered with
   compassion.

Question 8

6 national ambitions for palliative care

Answer 8

1 each person is seen as an individual
2 each person gets fair access to care
3 maximising comfort and well being
4 care is coordinated
5 all staff are prepared to care
6 each community is prepared to help

Question 9

Conclusion, the basic principles. for foundations of ambitions

Answer 9

• Patient autonomy
• Symptom management
• End of life care planning
• Co-ordination of care
• Staff in the right numbers with the right
training, the right experience and the right
tools to do what is needed

Question 10

effects of understanding uncertainty in medicine?

Answer 10

embracing
uncertainty could improve personal well-being,
construct effective mentorship, establish a culture
of respect throughout the institution, bring out
meaningful learning, and enhance sound doctor–
patient relationships and patient-centred care.

Question 11

what are the three sources of medicial uncertainty

Answer 11

technical, personal, and conceptual.
Technical uncertainty arises from inadequate or
incomplete scientific data and could be understood
as data-related uncertainty.
Personal uncertainty
arises from an uncertain doctor-patient
relationship.
Conceptual uncertainty arises from a
difficulty in applying data to real situations.

Question 12

what is a moral injury?

Answer 12

an injury to an individual’s moral
conscience and values resulting from an act of
perceived moral transgression, which
produces profound emotional guilt and
shame, and in some cases also a sense of
betrayal, anger and profound “moral
disorientation

Question 13

Non pharmalogical managment of covid symptoms

Answer 13

cough:

• Cough hygeine - catch it bin it kill it
• humdify room air
• sip oral fluids
• Avoid smoking

Fever:

• Reduce room temp
• Wear loose clothing
• Cool face with cloth
• Encurage oral fluids

Breathelessness:

• Positioning- sitting up right, shoulders drooped, head up, lean forwrad
• Relaxation techniques- mindfulness, meditation
• Reduce room temp

Delerium:

• Identidy and manage possible underlying cause or combination of causes
• Ensure effective communication and re-orientation
• provide reassurance to those with delirium
• if possible involve family, friends and carers to help