FOPC3 - End of life care Flashcards
What is the most common cause of death?
IHD and cancer
Accidents in young
Suicide in males aged 15-34
What does palliative care focus on?
Management. of conditions until terminal phase reached
Quality of life
MDT approach
Most from primary care with palliative specialist support
What are the. 4 step guidelines for identifying palliative care patients?
Ask
General clinical indicators
Two or more disease related indicators
Ask patient and family for supportive care needs
What is the Palliative Performance Scale based on?
Activity Evidence of disease Self-care Intake Conscious level Ambulation
What is palliative care according to WHO?
Relief from pain and other distressing symptoms
Affirms life and regards dying as normal process
Doesn’t hasten or postpone death
Integrates psychological and spiritual aspects
Offers support for patient and family
Team approach
Who are part of the palliative care team?
GP District nurse Pharmacist Receptionist Care manager Palliative specialist Religious support e.g Chaplain 3rd sector: MacMillan, CLAN, Marie Curie
What is considered a “good death” in the Western World?
Pain free Open acknowledgement At home with family 'Aware death' - resolve conflicts and unfinished business According to personal preference See death as personal growth
What is SPICT?
Supportive and Palliative Care Indicator Tool - identifies those at risk of deteriorating health and dying
Looks for two or more general indicators of deteriorating health and look for clinical indicators of one or more advance conditions.
What are signs of late stage heart disease where supportive and palliative care should take place?
NYHA Class III/IV HF SBP<100 HR >100 eGFR<30 2 or more acute episodes needing I therapy in past 6 months SOB/chest pain on minimal exertion
What is the function of the palliative performance scale?
Assess and monitor change in condition
Draw the disease trajectory graph.
…
What is the Gold Standards Framework?
Offers tools to provide palliative care at home
What is important when breaking bad news?
Listen Set the scene Find out what patient knows and how much they want to know Use common language Review and summarise Allow opportunity for Qs Agree follow-up and support
What does successful ageing depend on?
Individual and socio-cultural factors
What are the 5 stages of grief?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What is the difference for family members between sudden and expected loss?
Sudden = more difficult to adjust to
What is the DS1500 form?
Used for benefit claims for last 6-12 months of life (jump list for housing, access to benefits etc)
What medications should be prescribed in terminal phase?
For:
- Pain (opioids e.g morphine, fentanyl patches, NSAIDs)
- Agitation (benzodiazepines e.g midazolam)
- Respiratory secretions (anticholinergic drugs e.g hyoscine butyl bromide)
- Nausea (Anti-emetic e.g haloperidol, cyclizine, metoclopramide, levomepromazine)
- Breathlessness (positioning, fan, cool environment, oxygen, benzodiazepines, opioids)
*Administer via subcutaneous bolus or continuous subcutaneous infusion over 24hrs or via syringe pump.
What comfort measures are taken in last days of life?
Review meds
Reduce medical intervention to a minimal
Symptom control drugs
Regular oral care
Skin care
Bladder and bowel care
Always consider possible sources of stress other than pain
What is required for good care of the dying patient?
Recognition Care objectives Resuscitation status clarification Good communication Consider place of care Multiprofessional care Drugs
How do you recognise a patient is dying?
Daily continuous deterioration Profound weakness and drowsiness Difficulty taking things by mouth Poor concentration Disorientation Reduce peripheral perfusion with changes in skin colour and temperature Breathing pattern may change PPS is 10%
