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PHTY2230 > L28: Palliative Care in Older Adults > Flashcards

L28: Palliative Care in Older Adults Flashcards

1
Q

What are the 5 characteristics of death and dying in a contemporary society?

A
  1. Immunisation programs
  2. Improved sanitation and hygiene
  3. Institutionalisation scientific advances and medical technology
  4. Professional
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2
Q

What is the the main concept of death and dying i contemporary society?

A

People are living longer

→More likely to die from chronic disease

  • (eg. Heart disease, dementia/Alzheimers and cerebrovascular diseases)
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3
Q

What are the 3 main causes of death in the contemporary society?

A
  1. Heart disease
  2. dementia/Alzheimers
  3. Cerebrovascular diseases
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4
Q

What is palliative care based on the WHO?

A

“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.”

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5
Q

What are 7 WHO approaches to palliative care?

A
  1. 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)
  2. Promotes holistic care(ensures physical, psychological, social & spiritual well-being)
  3. Family and significant others are included in the care process
  4. Impeccable assessment, early identification of problems, early implementation of appropriate treatments
  5. Disease modifying treatments (e.g. chemotherapy- Cancer) may have a role
    • Help for comfort/could get rid of disease
  6. Palliative care can be provided in any setting
    • Hospital, aged care facility or patient’s home
  7. Team approach to care
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6
Q

Palliative care comes _____ in the course of an illness

A

early

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7
Q

Palliative care promotes _____ care (ensures physical, psychological, social & spiritual well-being)

A

holistic

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8
Q

______ and _____ are included in the care process for palliative care

A

Family; significant others

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9
Q

In palliative care, impeccable ____ , early _____ of problems, early implementation of appropriate ______

A

assessment; identification; treatments

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10
Q

_____ modifying treatments (e.g. chemotherapy) may have a role in palliative care

A

Disease

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11
Q

Palliative care can be provided in any _____.

A

setting

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12
Q

_____ approach to care for palliative care

A

Team

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13
Q

What are the 13 standards of palliative care?

A
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14
Q

What are 8 aims of palliative care?

A
  1. Retain the dignity of the patient, their caregiver/s and family
  2. Empower the patient, their caregiver/s and family
    • Self-management techniques
  3. Show compassion towards the patient, caregiver/s & family
  4. 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)
  5. Respect the patient, their caregiver/s and family
  6. Provide advocacy on behalf of the expressed wishes of patients, families and communities
  7. Provide excellence in the provision of care and support
  8. 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
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15
Q

What are 5 recipients of palliative care?

A
  1. End-stage Dementia
  2. End-stage Renal failure
  3. End-stage Cardiac, Respiratory, Liver disease
  4. Progressive Neuromuscular disorders
  5. MS, MND, Muscular Dystrophy
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16
Q

Palliative care is provided to people, regardless of age, who have ______ illnesses. It’s not dependent on medical _____, but on a person’s ______.

A

life-limiting; diagnosis; needs

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17
Q

What are 3 types of illness trajectories?

A
  1. Short period of evident decline
  2. Long term limitation with intermittent serious episodes
  3. Prolonged dwindling
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18
Q

What is “Short period of evident decline” as an illness trajectory?

A
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19
Q

What is “Long term limitation with intermittent serious episodes” as an illness trajectory?

A
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20
Q

What is “Prolonged dwindling “ as an illness trajectory?

A
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21
Q

What is an able response for “what will happen to me?”

A

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?
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22
Q

What are the 3 types of palliative care?

A

Primary Care Needs

Intermediate Needs

Complex Needs

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23
Q

What are the 5 characteristics of Primary Care Needs in Palliative Care?

A
  1. Largest sub-group
  2. Access to specialist care not required
    • Don’t have specialise need –> needs are met by all
  3. Needs met through own resources or support from primary care providers
  4. Majority of patients expected to have a non-malignant disease
  5. Eg. lymphodema, respiratory problems
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24
Q

What are the 4 characteristics of Intermediate Needs in Palliative Care?

A
  1. Patients who experience sporadic exacerbations of symptoms (e.g. pain, emotional distress)
  2. Temporary increase in level of need
    • Require specialist services –> just for short while
  3. Specialist palliative care services required
  4. Continued care from primary care provider
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25
Q

What are the 3 characteristics of Complex Needs in Palliative Care?

A
  1. Patients with complex physical, social, spiritual psychological, needs that do not respond to simple protocols of care
    • Don’t response to regular guidelines… etc
  2. Highly individualised care plans and specialist practitioners required
  3. Partnership with primary care providers
26
Q

What are the 3 locations of palliative care location?

A
27
Q

What are the 5 things palliative care at home is dependent on?

A
28
Q

What are 11 team players in palliative care?

A
  1. Patient
  2. Medical practitioner (e.g. GP, Pain clinic, Neurologist)
  3. Nurses
  4. Physiotherapists
  5. Social workers- Eg. after patient has died
  6. Clergy- Eg. after patient has died
  7. Pharmacists
  8. Occupational therapists
  9. Speech pathologists
  10. Complementary medicine practitioners (e.g. acupuncture)
  11. Family / Care givers
29
Q

What are the 3 Psychological & Social Responses to Loss?

A
  1. Loss of health, mobility, function, future potential dreams
  2. Need to cope with death
  3. Responses to loss evident at diagnosis/with disease progression
30
Q

What are 8 emotions that can in response to loss in palliative care?

A
31
Q

What are 5 ways to empower the patient and teach condition self management?

A
  1. Maximizing knowledgeabout condition
  2. Enabling recognition of signs &symptoms that he should seek help to managee.g. difficulties swallowing, increasing number of falls
  3. Talk about what might be introduced as various aspects of condition deteriorate e.g.gait & orthotics
  4. Alternatives to current method of doing ADLs as physical capacity declines
  5. Importance of keeping fit& how he might do this safely
32
Q

In palliative care, when teaching self management, it is important to ____ knowledge about condition

A

Maximize

33
Q

In palliative care, when teaching self management, it is important to enable ___________ e.g. difficulties swallowing, increasing number of falls

A

recognition of signs & symptoms that he should seek help to manage

34
Q

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

A

condition deteriorate

35
Q

In palliative care, when teaching self management, it is important to talk about alternatives to current method of doing ____ as physical capacity declines

A

ADL

36
Q

In palliative care, when teaching self management, it is important to talk about keeping _____ & how he might do this safely

A

fit

37
Q

What are 5 Patient-Defined Goals of Palliative Care

A
  1. Forget your own opinions
  2. Different personality types
  3. Put less emphasis on strict clinical reasoning and “better judgment”
  4. Do whatever you can in alignment with the patient’s ‘wants’: not your interpretation of their needs
  5. Enable patients to make decisions based on professional assessment & relevant options
38
Q

‘Patients and their nominated caregivers, where appropriate, are ______ in decisions about their care’

A

involved

39
Q

What are 5 Patient-Defined Goals within MDT Palliative Care?

A
  1. 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
  2. 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
  3. Providing information to the patient and caregiver
  4. A process of establishing goals of care, and re-evaluating treatment and care plans at critical times
  5. Identification of a designated point of contact & care coordinator
40
Q

What is an able response to “I thought I was going to die”?

A
  • 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?
41
Q

What are 3 characteristics in advance palliative care planning?

A
  1. Process which is constantly reviewed within a changing clinical context
  2. Process whereby a person thinks about and plans for their future medical care should they become unable to communicate
  3. 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
42
Q

What are the 2 characteristics of physiotherapy in palliative care?

A
  1. Management of troublesome symptoms
  2. Maintenance of functional capacity
43
Q

What are 8 major issues in palliative care?

A
  1. Ascites- Abnormal accumulation of fluid in the abdominal cavity (eg. sclerosis of liver)
  2. Oedema
    • Eg. lymphoedema
  3. Lack of confidence
  4. Medication reactions
  5. Cachexia (major weight loss)
    • Wasting syndrome (eg. cancer, heart failure, advanced pulmonary disease)
  6. Progressive/irregular decline in ability
  7. Disparity between perceived & actual physical ability
  8. Varying grief reactions
44
Q

What are 6 respiratory care for Breathlessness?

A
  • Underlying cause? (e.g. atrial fibrillation, therefore easily treated to improve comfort)
  1. Breathing Education
  2. Relaxation techniques
  3. Pursed Lip Breathing- Create back pressure which splits up airway to allow easier breathing
  4. Postural Education
  5. Stretches/Breathing Exercises
  6. Pacing Techniques
45
Q

What are 3 respiratory care for Clearing Secretions?

A
  • Will bony metastases in the ribs inhibit Rx choice?- Spreading of cancers
  • Primary problem is muscle weakness –suction?
  1. Effective coughing- Weak muscles –> use cather to help with getting rid of secretions manually
  2. Encourage fluid intake and huffing
  3. Postural drainage + manual techniques: extreme caution
46
Q

What are 2 characteristics of nociceptive pain?

A
  1. Pain →chemical or physical stimulation of nociceptors
  2. Either physiological (functional) or pathological (organic)
47
Q

What are 3 characteristics of neuropathic pain?

A
  1. Pain →damage or dysfunction of a nerve
  2. Central, peripheral of sympathetic type pain
  3. Most cancer pain –peripheral nerve damage
48
Q

What are 4 types of pain?

A
  1. Nocicpetive pain
  2. Neuropathetic pain
  3. Mixed pain (combination of all 3)
  4. Psychogenic pain
49
Q

What are 2 characteristics of psychogenic pain?

A
  1. Chronic pain problems
  2. Psychological factor
50
Q

What are 13 pain management for palliative care?

A
  1. TENS(gatetheory)
  2. Heat ± Ice
  3. Mobilisation
  4. PassiveMovement
  5. Hydrotherapy
  6. Massage
  7. Positioning
  8. Deepbreathing& Relaxation
  9. Reassurance&Education
  10. Ultrasound/Microwave–contraindications?
  11. Analgesics, Opioids and Adjuvants (synergists)
    • Paracetamol, NSAIDs, Corticosteroids ▫ Anti-depressants
    • Anti-convulsants
    • Anti-arrhythmics
    • Anti-psychotics
    • Anxiolytics
    • Topical creams, local anaesthetics
  12. Morphine, Oxycodone, Fentanyl, Methadone ▫ Constipation, sedation, nausea/vomiting, respiratory, depression
  13. Syringe Drivers/Patches/PRN orders
51
Q

What are 7 Analgesics, Opioids and Adjuvants (synergists)?

A
  1. Paracetamol, NSAIDs, Corticosteroids
  2. Anti-depressants- Not analgesics but have pain relieving properties
  3. Anti-convulsants- Not analgesics but have pain relieving properties
  4. Anti-arrhythmics- Not analgesics but have pain relieving properties
  5. Anti-psychotics
  6. Anxiolytics
  7. Topical creams, local anaesthetics
52
Q

What are 6 characteristics of skin integrity in palliative care?

A
  1. Protection and prevention
  2. Movement and circulation
  3. Positioning and regular re-positioning
  4. Equipment prescription:
    • Pressure mattresses, pressure relieving devices, chairs, beds
  5. Education of patient handling (manual handling)
  6. Avoidance of injury
53
Q

What is the treatment for skin integrity in palliative care?

A

Laser therapy in wound care (ulcers)

54
Q

What are 8 treatments for constipation in palliative care?

A
  1. Movement & mobility
  2. Massage
  3. Hot packs
  4. Positioning
  5. Hydration
  6. Nutrition(advice re. high fibrediet, fruit, prunes, metamucil)
  7. Education for prevention rather than treatment
  8. Routine management by other MDT members: Aperients (laxatives) →Suppository →Enema →Manual Evacuation
55
Q

What are 7 treatments for movement, mobility and independence in palliative care?

A
  1. Rehabilitation
  2. Functional Mobility
  3. Integration to activities and ‘normality’
  4. Facilitation of ADLs and independence
  5. Therapeutic Movement (joint mobility, passive/active-assisted)
  6. Assist the patient to live as actively as possible (WHO Goals)
  7. Equipment Prescription (mobility aids, chairs, beds, commodes)
56
Q

What are 7 characteristics for affirmation in palliative care?

A
  1. Give them time to speak –> don’t change subject for fear of them getting to sad
  2. It is important for them to be heard
  3. Patient has control
  4. Encourage to do what they desire
  5. Treatment interventions are now not the most important thing
  6. Quality of life is most important
  7. Still consider the importance of informed decision making by the patient and family
57
Q

What are 3 characteristics of education for others in palliative care?

A
  1. Respect patient: their expectations and disease-related choices
  2. Carers: stress management, health, choices, expectations
    • Patient (Manual) Handling –> Hoists, Slide sheets, Slide boards,
    • Back Care
    • Health Promotion for the caregivers
  3. Staff / Families Education for Others
58
Q

What are 10 sources of stress for caregiver in palliative care?

A
  1. Uncertainty about treatment
  2. Lack of knowledge about care
  3. Role changes in the family
  4. Strained financial resources
  5. Physical restrictions
  6. Threats to own health, well-being
  7. Lack of social support
  8. Fear of being alone
  9. Uncertain prognosis: limiting life plans
  10. Emotional and physical burnout
59
Q

What are the Advance Health Directives?

A
  • 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
60
Q

What are 7 characteristics of Advance Health Directives?

A
  1. Instructions that consent to, or refuse, specified medical treatments
  2. Clearly states patient care goals and preferences
  3. May be completed by a legally competent patient or by a legally appointed proxy (e.g. enduring power of attorney)
  4. May be completed as part of the advance care planning process
  5. Has legal status
  6. Must be available when the individual’s place of care is being changed (i.e. home to hospital)
  7. Varies according to each Australian state/territory

PHTY2230 (24 decks)

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