L28: Palliative Care in Older Adults Flashcards
What are the 5 characteristics of death and dying in a contemporary society?
- Immunisation programs
- Improved sanitation and hygiene
- Institutionalisation scientific advances and medical technology
- Professional
What is the the main concept of death and dying i contemporary society?
People are living longer
→More likely to die from chronic disease
- (eg. Heart disease, dementia/Alzheimers and cerebrovascular diseases)
What are the 3 main causes of death in the contemporary society?
- Heart disease
- dementia/Alzheimers
- Cerebrovascular diseases
What is palliative care based on the WHO?
“Palliative care is an approach that improves the quality of life of patients & their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment & treatment ofpain& other problems, physical, psychosocial& spiritual.”
What are 7 WHO approaches to palliative care?
- Palliative care comes earlyin the course of an illness- What are the symptoms, onsets, interventions for management
- Can teach some strategies to manage problems (eg. will have problems swallowing –> teach them how to self-manage)
- Promotes holistic care(ensures physical, psychological, social & spiritual well-being)
- Family and significant others are included in the care process
- Impeccable assessment, early identification of problems, early implementation of appropriate treatments
- Disease modifying treatments (e.g. chemotherapy- Cancer) may have a role
- Help for comfort/could get rid of disease
- Palliative care can be provided in any setting
- Hospital, aged care facility or patient’s home
- Team approach to care
Palliative care comes _____ in the course of an illness
early
Palliative care promotes _____ care (ensures physical, psychological, social & spiritual well-being)
holistic
______ and _____ are included in the care process for palliative care
Family; significant others
In palliative care, impeccable ____ , early _____ of problems, early implementation of appropriate ______
assessment; identification; treatments
_____ modifying treatments (e.g. chemotherapy) may have a role in palliative care
Disease
Palliative care can be provided in any _____.
setting
_____ approach to care for palliative care
Team
What are the 13 standards of palliative care?
What are 8 aims of palliative care?
- Retain the dignity of the patient, their caregiver/s and family
- Empower the patient, their caregiver/s and family
- Self-management techniques
- Show compassion towards the patient, caregiver/s & family
- Provide equity in access to palliative care services &resource allocation
- Having plans in place to make sure that they are available if the patient is not longer able to show/say their desires (eg. DOR..etc)
- Respect the patient, their caregiver/s and family
- Provide advocacy on behalf of the expressed wishes of patients, families and communities
- Provide excellence in the provision of care and support
- Be accountable to patients, caregiver/s, families & the community
- Make the patient aware that you will be sharing confidential information - Pass information to patient if learn something at eg. forum, conference
What are 5 recipients of palliative care?
- End-stage Dementia
- End-stage Renal failure
- End-stage Cardiac, Respiratory, Liver disease
- Progressive Neuromuscular disorders
- MS, MND, Muscular Dystrophy
Palliative care is provided to people, regardless of age, who have ______ illnesses. It’s not dependent on medical _____, but on a person’s ______.
life-limiting; diagnosis; needs
What are 3 types of illness trajectories?
- Short period of evident decline
- Long term limitation with intermittent serious episodes
- Prolonged dwindling
What is “Short period of evident decline” as an illness trajectory?
What is “Long term limitation with intermittent serious episodes” as an illness trajectory?
What is “Prolonged dwindling “ as an illness trajectory?
What is an able response for “what will happen to me?”
listen to what patient is saying (concerns, feelings and saying) –> patient wants to be heard
- Has that been on your mind lately?
- You think it will happen sooner rather than later?
- It must be very frightening
- To be honest, I don know what your future holds
- You came in quite sick but you have made some recovery
- Talk to your team about this? And talk you through it?
What are the 3 types of palliative care?
Primary Care Needs
Intermediate Needs
Complex Needs
What are the 5 characteristics of Primary Care Needs in Palliative Care?
- Largest sub-group
- Access to specialist care not required
- Don’t have specialise need –> needs are met by all
- Needs met through own resources or support from primary care providers
- Majority of patients expected to have a non-malignant disease
- Eg. lymphodema, respiratory problems
What are the 4 characteristics of Intermediate Needs in Palliative Care?
- Patients who experience sporadic exacerbations of symptoms (e.g. pain, emotional distress)
- Temporary increase in level of need
- Require specialist services –> just for short while
- Specialist palliative care services required
- Continued care from primary care provider
What are the 3 characteristics of Complex Needs in Palliative Care?
- Patients with complex physical, social, spiritual psychological, needs that do not respond to simple protocols of care
- Don’t response to regular guidelines… etc
- Highly individualised care plans and specialist practitioners required
- Partnership with primary care providers
What are the 3 locations of palliative care location?
What are the 5 things palliative care at home is dependent on?
What are 11 team players in palliative care?
- Patient
- Medical practitioner (e.g. GP, Pain clinic, Neurologist)
- Nurses
- Physiotherapists
- Social workers- Eg. after patient has died
- Clergy- Eg. after patient has died
- Pharmacists
- Occupational therapists
- Speech pathologists
- Complementary medicine practitioners (e.g. acupuncture)
- Family / Care givers
What are the 3 Psychological & Social Responses to Loss?
- Loss of health, mobility, function, future potential dreams
- Need to cope with death
- Responses to loss evident at diagnosis/with disease progression
What are 8 emotions that can in response to loss in palliative care?
What are 5 ways to empower the patient and teach condition self management?
- Maximizing knowledgeabout condition
- Enabling recognition of signs &symptoms that he should seek help to managee.g. difficulties swallowing, increasing number of falls
- Talk about what might be introduced as various aspects of condition deteriorate e.g.gait & orthotics
- Alternatives to current method of doing ADLs as physical capacity declines
- Importance of keeping fit& how he might do this safely
In palliative care, when teaching self management, it is important to ____ knowledge about condition
Maximize
In palliative care, when teaching self management, it is important to enable ___________ e.g. difficulties swallowing, increasing number of falls
recognition of signs & symptoms that he should seek help to manage
In palliative care, when teaching self management, it is important to talk about what might be introduced as various aspects of ______ e.g.gait & orthotics
condition deteriorate
In palliative care, when teaching self management, it is important to talk about alternatives to current method of doing ____ as physical capacity declines
ADL
In palliative care, when teaching self management, it is important to talk about keeping _____ & how he might do this safely
fit
What are 5 Patient-Defined Goals of Palliative Care
- Forget your own opinions
- Different personality types
- Put less emphasis on strict clinical reasoning and “better judgment”
- Do whatever you can in alignment with the patient’s ‘wants’: not your interpretation of their needs
- Enable patients to make decisions based on professional assessment & relevant options
‘Patients and their nominated caregivers, where appropriate, are ______ in decisions about their care’
involved
What are 5 Patient-Defined Goals within MDT Palliative Care?
- Supporting patients & caregivers to participate in care planning:
- including explaining the concept of the MDT approach/taking part in a care planning meeting
- Talk about symptoms and what we did today and I will share this with the eg. dietician..etc
- Informing patients & caregivers that their case may be discussed at a team level with health professionals they have not met:
- obtaining patient consent for this
- Providing information to the patient and caregiver
- A process of establishing goals of care, and re-evaluating treatment and care plans at critical times
- Identification of a designated point of contact & care coordinator
What is an able response to “I thought I was going to die”?
- Maintain focus on what the patient has said (wishes, values and preferences)
- Response in a genuine way
- Silence is okay
Able:
- Do not brush away/change subject (nah, you will be fine)
- Empathetic and interesting
- Have you felt like that before?
- I don’t blame you for being frighted?
- How were you managing at home? Family
- Good that you have family around
- Is that want frightens you the most? (eg. being a burden)
- Lets try and get you as independent as possible? How does that sound?
What are 3 characteristics in advance palliative care planning?
- Process which is constantly reviewed within a changing clinical context
- Process whereby a person thinks about and plans for their future medical care should they become unable to communicate
- Promotes open and ongoing communication between patients, their families and health care professionals about end of life decisions
- Once they get to a point where they can no longer communicate –> need to have plans
What are the 2 characteristics of physiotherapy in palliative care?
- Management of troublesome symptoms
- Maintenance of functional capacity
What are 8 major issues in palliative care?
- Ascites- Abnormal accumulation of fluid in the abdominal cavity (eg. sclerosis of liver)
- Oedema
- Eg. lymphoedema
- Lack of confidence
- Medication reactions
- Cachexia (major weight loss)
- Wasting syndrome (eg. cancer, heart failure, advanced pulmonary disease)
- Progressive/irregular decline in ability
- Disparity between perceived & actual physical ability
- Varying grief reactions
What are 6 respiratory care for Breathlessness?
- Underlying cause? (e.g. atrial fibrillation, therefore easily treated to improve comfort)
- Breathing Education
- Relaxation techniques
- Pursed Lip Breathing- Create back pressure which splits up airway to allow easier breathing
- Postural Education
- Stretches/Breathing Exercises
- Pacing Techniques
What are 3 respiratory care for Clearing Secretions?
- Will bony metastases in the ribs inhibit Rx choice?- Spreading of cancers
- Primary problem is muscle weakness –suction?
- Effective coughing- Weak muscles –> use cather to help with getting rid of secretions manually
- Encourage fluid intake and huffing
- Postural drainage + manual techniques: extreme caution
What are 2 characteristics of nociceptive pain?
- Pain →chemical or physical stimulation of nociceptors
- Either physiological (functional) or pathological (organic)
What are 3 characteristics of neuropathic pain?
- Pain →damage or dysfunction of a nerve
- Central, peripheral of sympathetic type pain
- Most cancer pain –peripheral nerve damage
What are 4 types of pain?
- Nocicpetive pain
- Neuropathetic pain
- Mixed pain (combination of all 3)
- Psychogenic pain
What are 2 characteristics of psychogenic pain?
- Chronic pain problems
- Psychological factor
What are 13 pain management for palliative care?
- TENS(gatetheory)
- Heat ± Ice
- Mobilisation
- PassiveMovement
- Hydrotherapy
- Massage
- Positioning
- Deepbreathing& Relaxation
- Reassurance&Education
- Ultrasound/Microwave–contraindications?
- Analgesics, Opioids and Adjuvants (synergists)
- Paracetamol, NSAIDs, Corticosteroids ▫ Anti-depressants
- Anti-convulsants
- Anti-arrhythmics
- Anti-psychotics
- Anxiolytics
- Topical creams, local anaesthetics
- Morphine, Oxycodone, Fentanyl, Methadone ▫ Constipation, sedation, nausea/vomiting, respiratory, depression
- Syringe Drivers/Patches/PRN orders
What are 7 Analgesics, Opioids and Adjuvants (synergists)?
- Paracetamol, NSAIDs, Corticosteroids
- Anti-depressants- Not analgesics but have pain relieving properties
- Anti-convulsants- Not analgesics but have pain relieving properties
- Anti-arrhythmics- Not analgesics but have pain relieving properties
- Anti-psychotics
- Anxiolytics
- Topical creams, local anaesthetics
What are 6 characteristics of skin integrity in palliative care?
- Protection and prevention
- Movement and circulation
- Positioning and regular re-positioning
- Equipment prescription:
- Pressure mattresses, pressure relieving devices, chairs, beds
- Education of patient handling (manual handling)
- Avoidance of injury
What is the treatment for skin integrity in palliative care?
Laser therapy in wound care (ulcers)
What are 8 treatments for constipation in palliative care?
- Movement & mobility
- Massage
- Hot packs
- Positioning
- Hydration
- Nutrition(advice re. high fibrediet, fruit, prunes, metamucil)
- Education for prevention rather than treatment
- Routine management by other MDT members: Aperients (laxatives) →Suppository →Enema →Manual Evacuation
What are 7 treatments for movement, mobility and independence in palliative care?
- Rehabilitation
- Functional Mobility
- Integration to activities and ‘normality’
- Facilitation of ADLs and independence
- Therapeutic Movement (joint mobility, passive/active-assisted)
- Assist the patient to live as actively as possible (WHO Goals)
- Equipment Prescription (mobility aids, chairs, beds, commodes)
What are 7 characteristics for affirmation in palliative care?
- Give them time to speak –> don’t change subject for fear of them getting to sad
- It is important for them to be heard
- Patient has control
- Encourage to do what they desire
- Treatment interventions are now not the most important thing
- Quality of life is most important
- Still consider the importance of informed decision making by the patient and family
What are 3 characteristics of education for others in palliative care?
- Respect patient: their expectations and disease-related choices
- Carers: stress management, health, choices, expectations
- Patient (Manual) Handling –> Hoists, Slide sheets, Slide boards,
- Back Care
- Health Promotion for the caregivers
- Staff / Families Education for Others
What are 10 sources of stress for caregiver in palliative care?
- Uncertainty about treatment
- Lack of knowledge about care
- Role changes in the family
- Strained financial resources
- Physical restrictions
- Threats to own health, well-being
- Lack of social support
- Fear of being alone
- Uncertain prognosis: limiting life plans
- Emotional and physical burnout
What are the Advance Health Directives?
- Legal documents in which adult persons with capacity can set out their decisions about future treatment
- Advance Directives come into effect if that person is unable to make reasonable judgments about their treatment later on- - Once they are unable to communicate
Anything that can save or prolong their life
- Need to be addressed in the legal document
What are 7 characteristics of Advance Health Directives?
- Instructions that consent to, or refuse, specified medical treatments
- Clearly states patient care goals and preferences
- May be completed by a legally competent patient or by a legally appointed proxy (e.g. enduring power of attorney)
- May be completed as part of the advance care planning process
- Has legal status
- Must be available when the individual’s place of care is being changed (i.e. home to hospital)
- Varies according to each Australian state/territory
