Hospice and Palliative Care Flashcards
Palliative Care =
patient and family-centered care
optimizes quality of life by anticipating, preventing, and treating suffering
Palliative care throughout the continuum of illness involves addressing the physical, intellectual, emotional, social and spiritual needs and to facilitate patient autonomy, access to information, and choice
General Principles of Palliative and Hospice Care
Client and family as unit of care
Attention to physical, psychological, social and spiritual needs
Interdisciplinary team approach
Education and support of client and family
Extends across illnesses and settings
Bereavement support
Hospice Care =
Ideally a patient living with chronic, debilitating or progressive disease receives palliative care throughout the course of the disease, and as death approaches, services are seamlessly increased to meet the patient’s individual needs
A diagnosis of six months or less to live
A desire to pursue comfort care over curative treatment
Goal is symptom management
Hospice Eligibility- highly regulated to qualify for reimbursement of services
Life-limiting condition with a prognosis of six months or less if their disease runs its normal course
Frequent hospitalizations in the past six months
Progressive weight loss (taking into consideration edema weight)
Increasing weakness, fatigue, and somnolence
A change in cognitive and functional abilities
Compromised Activities of Daily Living (ADLs)
Deteriorating mental abilities
Recurrent Infections
Skin breakdown
Specific decline in condition
Palliative Care vs. Hospice Care
Palliative Care- continue with life prolonging therapies/treatments.
Hospice Care- comfort care; no longer therapies/treatments to prolong life.
Curative and Palliative Approaches to Care
Palliative Focus
Client/Family identify unique end of life goals
Assess how symptoms, issues are helping/hindering reaching goals
Interventions to promote comfort
Curative treatment still indicated if desired
Quality of life closure
Principles of Hospice Care
All principles of palliative care apply
Difference is the shift is made to comfort care rather than curative care
No longer curative treatments
Symptom control
Attention to psychological, social and spiritual needs
Palliative Care and Hospice Care
Expert symptom relief
Suffering can be decreased
Allows for client and family to attend to issues
Patient and Family- unit of care
Relationship repair/enhancement as indicated
Goals of Care
Patient/Family Goals of Care
Goal directed care
Quality of Life- paramount
Role of Physical Therapy
Assist the patient in maintaining functional abilities for as long as they possibly can.
Reduce the burden of care for caregivers involved, including friends and family members.
Assist in pain control.
Active interprofessional team member.
PT Interventions
Pain management and relief
Positioning to prevent pressure sores, lessen pain, prevent contractures, and help with breathing and digestion
Endurance training and energy-conservation techniques
Gait training, transfers, safety instruction, stair climbing
Therapeutic exercises
Management of edema, a condition characterized by an excess of water in the body
Equipment recommendations, training and modification
Home modifications
Prognostication
Is poor for many non-cancer diagnoses
Referral is often made when death is imminent
Autonomy
Person’s right to self-determination, unrestricted by the control of others, even when it contradicts clinician’s recommendation
Hospice philosophy strongly supports client choice
Greatest fears
> being abandoned
> pain
Informed DECISIONS
Built on ethical principle of veracity or truth telling.
Truth telling is essence of open, trusting relationship.
Sense of knowing often relieves burden of the unknown
Patient Autonomy
Dignity and Respect
Accept patients and families “where they are”
Health Care Provider’s Role
Advocate, educate, and support patient’s and family’s decision
Concept of Suffering
State of severe distress that threatens intactness of the person.
Failure to respond to client’s needs intensifies suffering.
Identify sources of suffering.
Therapeutic Communication
Some things cannot be fixed.
Use of therapeutic presence
Maintaining realistic perspective
Presence
A way of expressing compassionate caring.
To be present with the dying and their families is to allow oneself to enter into another’s world and to respond with compassion
Presence may in fact be our greatest gift to these patients and families
Advanced Care Planning
Is the process whereby a patient, in consultation with health care providers, family members, and important others, makes decisions about his/her future healthcare.
Advanced Directives- are written documents that may be an instructional directive, a proxy, or both.
Advanced Directives
Provide instruction regarding a patient’s wishes about life-sustaining treatment, often including ventilators and feeding tubes.
Patients with decision-making capacity have the right to refuse any treatment.
Advanced Directives extend these same rights when decision-making capacity is compromised
Common Medications Used in End of Life Care
Analgesics
Opioids
Block release of neurotransmitters that are involved in processing pain.
Adverse effects- extremely rare
Medications
Morphine Sulfate: Most commonly used
Gold Standard, Highly effective with pain and breathlessness (shortness of breath) management
Dilaudid (Hydromorphone): Synthetic Opioid, useful when patient is allergic to Morphine Sulfate
Fentanyl
Transdermal-Fentanyl Patch = useful when client can not swallow, does not remember to take medications or has side effects to other opioids.
Trans mucosal; Lollipop
Comfort at Death
Primary Symptoms Requiring Intervention:
Pain
Dyspnea
Respiratory secretions
Restlessness
Agitation
Clinical Signs as Death Approaches
Vital Signs
Respirations become shallow and often increase.
Increasing difficulty swallowing
Death Rattle/ Respiratory Congestion
Noisy, moist sound
Very scary to family
Patient usually unaware
Treat with repositioning and medication as indicated (Scopolamine Patch)
Profound weakness
Gaunt and pale physical appearance
Drowsiness and/or minimal responsiveness
Lack of interest in food and fluids
Body becomes cool- extremities cool first
Mottling- extremities first
