ILA Flashcards
What are the main principles for palliative care symptom management?
- Accurate assessment of patients physical, psychological, social and spiritual needs (Holistic approach)
- MDT approach
- Patient centred care
- Accurate record keeping
How to help control nausea and vomiting?
- Antiemetics with consideration of route of administration.
- Avoiding foods/strong smells/eating small portions/ regulation of bowel habits.
How to help control dyspnoea?
- Oxygen therapy/nebulisers and treat causes.
- Fans, breathing techniques through self management.
How to help control constipation?
- Minimal symptoms but can affect quality of life badly.
- Usually due to opioids, effects of disease or poor appetite or dehydration.
- Use of laxatives about making defecation more comfortable instead of increasing the frequency.
- Stimulant laxatives can be used such as Senna or osmotic laxatives such as Macrigol.
- Suppositories or enemas can be used alternatively.
How to help control anxiety/depression/agitation?
- These can be controlled through antidepressants/counselling/mindfulness etc.
- Usually due to the patient being lonely, poorly managed symptoms, constipation, their thoughts and feelings towards their disease and their future.
- ‘Terminal’ agitation can often occur in the last few days or hours of life.
How to help control pain?
- WHO analgesic ladder ranging from paracetamol to morphine.
- Syringe pumps can be used to give constant pain relief, in particular for patients with dysphagia or vomiting.
How to help control fatigue?
- Exercise diary, daily conservative plan or physical activity if possible.
How to help control excessive respiratory secretions?
- Can be distressing for patients and their families.
- Due to build of fluid within the airway that leads to gurgling or rattling.
- Repositioning patient to upright position to encourage drainage is important and potential to use Atropine to reduce saliva.
How to help control dehydration and lack of appetite?
- This can be caused through dysphagia.
- Management of dysphagia includes soft food diet, thickened liquids, extra oral support and artificial diet.
- Speech and language referral required.
- Moistening of lips can help with thirst and preventing cracked lips through ice cubes and wet sponges.
What is palliative care?
- Holistic way of providing comfort to patients and their families during an end of life illness. It can be patients with cancer, end stage organ failure, the elderly or frail.
- Looking at social, psychological, physical and spiritual needs.
- Many patients at end of life die in hospital despite having preferred to be at home.
What is the gold standard framework?
- A primary care based approach to formalise best practise and patient centred care.
- 5 main goals include managing symptoms, identifying patient wishes in terms of their preferred place to die, also ensuring staff or educated as well as competent and confident.
- 3 main processes involve identifying needs, accessing them and putting a plan in place with the patient.
What is the Liverpool care pathway?
- Initially created for generalist staff in hospital but extended to GP and care homes/
- Used in the last few days and weeks of life.
- Assessing physical, psychological, social and spiritual.
What are the best practise points?
- MDT, assessing patient and carers regularly, anticipate needs, note them down and work out how to solve the, communication and also discussion around preferred place of death and ensure it is noted.
What members of the MDT?
- GP, DN, hospices, social services and families.
What challenges are felt in palliative care?
- Lack of 24 hour care, struggles for equipment, limited specialist palliative care, inequalities in terms of care and also favouring towards palliative care, lack of communication.
What is euthanasia?
- Deliberately ending a person’s life to relieve suffering. Usually due an incurable condition.
What types of euthanasia?
- Voluntary - where the patient has capacity and communications their wish to die.
- Non voluntary - where the patient is unable to communication and someone else makes a decision for them, potentially through previous concentrations.
- Active - deliberately causing.
- Passive - withholding/withdrawing treatment.
What is assisted suicide?
- Encouraging someone or deliberatley assisting someone with death.
- All illegal and could be charged with manslaughter.
What are advanced directives?
- Decisions made by a patient in advance, whilst they have capacity to outline their preferences in terms of their end of life care - specifically the refusal of life sustaining treat - also known as ‘living wills.’
What are advanced statements?
- Patients personal preferences about the way they are cared for and specifics related to their quality life.
- Type to refuse and when to refuse it.
DNACPR
- Don’t attempt resuscitation.
- CPR = Chest compression, electrical or artificial stimulation and /or use of medication.
- Can lead to fractured ribs, spleen and liver and brain damage.
What is a good death?
- Treating the patient as an individual with respect and dignity, without pain and symptoms in familiar surroundings with patients they wish to be with.
What is lasting power of attorney for Health and Welfare?
- This gives a person a right to trust someone to make decisions when they lose mental capacity and patient decides if this includes life sustaining treatment.
What are the 7C’s?
- Communication, coordination, control of symptoms, continuity of care, continued education, carer support and care in the dying phase.
What are the 3 central processes of GSF?
- Identify key group of patients (using a register and agreed criteria)
- Assess their main needs both physical and psychosocial.
- Plan ahead for problems, including out of hours services.
What is shared decision making?
- HCP should give all the information and facts in order to make an informed decision, discussing the risks and benefits of the options. Patients given the opportunity to ask questions and reflect.
What are ethical conflicts in decision making?
- Explaining the risks of procedures - patient doesn’t need all info, clinician bias and difficulty understanding.
CHA2DS2VASC Score
- Used to predict stroke risk in patients who have AF.
- Increased score leads to increased risk.
- Score of 2 or more = anticoagulation with warfarin, INR 2-3 or DOAC.
HASBLED Score
- Scoring to assess the risk of 1 year bleeding risk in a patient who is on anti coag for AF.
- Score of 3 or more would indicate high risk and caution needed.
- Warfarin should be given to patients as its more easily reversible.
- Higher weighting.
ABCD2 Score
- Assess stroke risk following the 7 days after a TIA - based on age, BP, clinical features, duration of TIA and diabetics.
QRISK2 Score
- Prediction algorithm of the person developing CVD over 10 years.
How are falls prevented?
- Framework to reduce the number of falls causing serious injury and effective treatment and rehab for those that do fall.
- Older people should be asked about falls at routine apts, risk assessment carried out, DEXA scanning for osteoporosis and referral.
- Limited funds and resources and also resistance.
What are intrinsic factors for falls?
- Age related such as reduced visual ability, reduction hearing and muscle strength and tone.
- Pathological such as endocrine, neuro and endocrine.
What are extrinsic factors for falls?
- Obstacles, bad lightening, inadequate footwear and clothing.
What are fits/seizures?
- Sudden burst of electrical activity within the brain, leading to temporary affects of function.
- It can be occur anywhere between seconds and minutes.
What are the types of fits?
- Focal = one area of the brain with/without loss of consiusness.
- General = absence (staring into space), tonic (muscle stiffness), atonic (loss of muscle control), clonic (rhythmic jerking) and myoclonic (sudden briefing jerks).
What are syncope?
- Sudden loss of consciousness, usually associated with lack of ability to maintain postural tone.
What are they types of syncope?
- Vasovagal (usually caused by prolonged periods of sitting, emotinal stress, pain, heat and alcohol)
- Cardio (Structural heart disease or anything that decreases cardiac output)
- Orthostatic hypotension (Common in elderly, reduction in 20 mmHg in systolic and 10 mmHg in diastolic BP within 3 minutes)
What does elderly care involve?
- On admission to hospital: A detailed and accurate patient record, review assessment and give estimated discharge date.
- During admission: Regular MDT and assess for discharge.
- 48 hrs prior to discharge: Inform MDT, initiate referrals, contact agencies for patient equipment, order medicine and arrange transport.
- Day of discharge: Contact family and carers to confirm follow up care, check documents, send letter to GP, reinforce behaviours.
- Follow up: Initiate care package with GP.
What psychosocial factors should be considered in terms of dermatological skin conditions?
- Stigmatisisms, decreased body image and self esteem, withdrawal, anxiety/depression, OCD, scratch itch cycle, sexual and physical relationship issues, decreased quality of life, covering up of the skin.
Common triggers for skin conditions?
- Allergens such as pollen, pet dander, house dust mites, fungus, mould, environmental triggers such as cold dry weather, dampness and also dietary factors such as cows milk eggs, gluten, wheat and peanuts, soya as well as stress and emotional triggers.
What are the rules around self prescribing?
- Legal in the UK but discouraged by the GMC.
- This is due to issues with overdosing, addiction, lack of adequate documentation, risk of ADR’s and independant judgement.
- Can use in emergency situations.
What are complications associated with obesity in pregnancy?
- Increased risk of gestational diabetes, miscarriage, pre eclampsia, difficulties with birth, larger baby, increased risk in need for instrumental delivery.
What are complications associated with conceiving later in life?
- Increased miscarriage, pregancy related hypertension or gestational diabetes, twins/triplets, pre eclampsia or complications with delivery.