End of Life Issues Lecture Powerpoint Flashcards
Karnofsky performance scale (KPS)
A measure of functional status used for geriatric populations on a scale of 0 (dead)-100 (normal), at 50 denotes requiring considerable assistance and frequent medical care being unable to care for self, key turning point marker as after here sees exponential drop in life
4 leading causes of death in US
- heart disease
- cancer
- accidents
- chronic lower respiratory dz
How does alzheimer’s kill?
Typically from a complication as a result, such as aspiration after forgetting muscle memory of swallowing or starvation
REMAP acronym for transition from disease oriented treatment of geriatric patient to comfort care and quality of life treatment (palliative)
Reframe why status quo isn't working Expect emotion and respond with empathy Map out whats important and understand their values Align with a patients values Plan to match their values
Ask tell ask principle
When relaying bad news to a patient should ask how they prefer to receive info, tell the info and allow silence, and then ask them to confirm they heard and clarify
Hospice care
Provides support and care for those in the last phases of life limiting illness, recognizes dying as part of normal process of living, affirms life and neither hastens nor postpones death, focuses on quality of life for individuals and their family caregivers
Core aspects of hospice (3)
- patient/family focused
- volunteers and grief bereavement support
- pharmaceuticals and supplies
Respite in patient care
short term relief for primary care givers to recover from demands of daily home care
Limitations for PAs on hospice care (3)
- can only provide hospice care since 2019
- only physician can certify a terminal illness
- are not main provider and cannot prescribe medications
Palliative care
Treatment that enhances comfort and improves quality of an individuals life during last phase, hospice is a type of it, expected outcome is relief over no set time expectation and typically has more limited scope than hospice (usually just providers and not a team of social workers and volunteers)
POLST
Physician orders for life sustaining treatment, form completed by MD or PA that lists out what a patient wants regarding CPR, medical intervention, antibiotics, hydration and nutrition, can be changed or revoked at any time
Healthcare agent and healthcare representative
An individual designated in an advanced care directive, if not manually appointed typically goes to spouse then brother then child etc (healthcare representative)
Therapeutic nihilism
Not believing in the value of treatment and believing treatment is useless so doing nothing is acceptable (very toxic mentality in medicine!!!)
Common signs and symptoms near end of life (6)
- pain
- dyspnea/apneic pauses
- tachypnea
- agonal breathing
- mottling of skin
- fever
Morphine (roxanol) in end of life care
-indicated for pain, dyspnea, tachypnea, can be administered sublingually in some cases but contraindicated in renal failure, metabolites are neurotoxic so if build up can cause myoclonus or delerium
