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Palliative and EOLC > Midterm > Flashcards

Midterm Flashcards

1
Q

Palliative care

A

Improves QOL for patients and families facing life-threatening illness

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2
Q

4 components of palliative care

A

Prevention and relief of suffering
Early identification
Assesment
Pain treatment

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3
Q

6 principles of palliative care

A 
Patient and family are a unit
systematic assessment of physical and emotional needs
Communciation and support throughout 
Releive symptoms promptly
Plan ahead and prevent problems
Team approach
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4
Q

Hospice

A

Patient centred holistic care focusing on QOL and extending support to families

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5
Q

EOLC

A

Focus on last 6 months of life

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6
Q

% of HIV patients in developing countries

A

98%

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7
Q

% of opioids consumed in western countries

A

90%

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8
Q

Developing world resources

A

5% of cancer resources but 2/3 patients

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9
Q

% of hospital beds taken by EOL patients who dont want it

A

20%

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10
Q

% of people who die in hospitals

A

60%

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11
Q

Increase in elderly pop

A

2-3x

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12
Q

People that can benefit from palliative care but dont get it

A

100 million

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13
Q

Support and Palliative care indicators tool

A

Used identify advanced illness and those in need of palliative care

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14
Q

6 steps to palliative care

A 
Discussion about end of life
Assesment, care planning and review 
Coordination of care 
Delivery of high quality services in different settings
Care in the last days of life
After detah--> bereavemnt
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15
Q

Palliative care areas to imporve

A

Recognition of those who are dying
Out of working hoiurs service
Patients without cancer
Greater cultural consideration

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16
Q

7 Cs Gold standrad of PC

A 
Communication
Coordination 
Control of symptoms 
Conitnuity out of hours
Continued learning 
Carer supports 
Care in the dying phase
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17
Q

5 rights of patients

A 
Confidentiality
Pain control 
setting of death 
Degree of carer involvement 
Deny illness
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18
Q

% who think of EOL issues

A

74%

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19
Q

% that support palliative care

A

96%

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20
Q

% that prefer to die at home

A

75%

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21
Q

hours of caregiving required ot die at home

A

54 hrs/week

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22
Q

Canadas ranking for quality of death

A

11/80

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23
Q

% who suffer from chronic illness

A

32%–> 74% of seniors have more than one

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24
Q

% of deaths from chronic illness

A

70%

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25
Q

Dementia prevalance

A

8% 65 and up

1/3 over 85

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26
Q

Amount saved with hospital based PC

A

2.1 billion–> 50% savings

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27
Q

% who feel they cant care give for family

A

65%

28
Q

$ from informal care giving

A

25 billion

29
Q

Informal care giver

A

54% women
44% aged 45-64
28% are raisign children

30
Q

4 major conditons requiring care

A

Aging (28%)
Cancer (11%)
CVD (9%)
Mental illness (7%)

31
Q

% of PC doctors who focus on palliative care, and who are specialists

A

12% focus on PC

5% are specialists

32
Q

% of PC docs that do home visits

A

68% for Canada
75% in ontario
44% in Quebec

33
Q

Symptoms of dying

A

Fatigue
Respiratory secretions
Mouth care
Restlessness and agitation

34
Q

4 things needed to die at home

A

Family or care givers
Adequate nursing care
Night sitting service
Access to specialist palliative care

35
Q

4 quality outcomes of terminal care

A

Preffered place of death
successful symptom management
Spiritual care
Good experience for care givers

36
Q

4 psychosocial needs

A

fear
guilt
anger
uncertainty

37
Q

DNACPR

A

do not attempt cardiopulmonary resuscitation . Order discussed and kept with patient

38
Q

4 components of general care at EOL

A

Positioning and pressure care
Mouth and eye care
Bladder and bowel care
Fluid and nutrition

39
Q

Death anxiety

A

Thought by Freud and sociologists to bind and preserve social groups

40
Q

4 factors in a death system

A

Exposure to detah
life expectancy
Percieved control over forces of nature
Perception on what it means to be human

41
Q

3 levels in evealution of spirituality

A

Routine asessmenrt –> all patients
Multidiscliplinary assessment
Specialist assessment

42
Q

Kubler Ross stages

A 
Denial
Anger
Bargaining 
Depression 
Acceptance
43
Q

Total pain

A

Includes emotional, social and spiritual suffering as well as physical

44
Q

Frued

A

Reality of death is repeatedly tested until attachment from deceased is withdrawn

45
Q

Bowlby 4 stages of bereavemrnt

A

numbing
yearning and searching
disorganization and despair
Reorganisation

46
Q

Wordens tasks of bereavement

A

Accept reality of loss
Work through pain and grief
Adjust to environment which person is missing
Emotionally relocate desceased and move on

47
Q

Strobe and Schut Dual process theory of coping

A

Oscillate betwen loss and restoration

48
Q

Klass. et al

A

No breaking down of bonds, just create a new healthy attachment that is compatible with existing relationships

49
Q

Range of response to loss

A

Overwhelmed–> immediate response
Controlled: Emotions are avoided
Vulnerability: Can persist in those with limited capacity
Resilience: Growing inner strength

50
Q

Adult attitude to grief scale

A

Assess level of vulnerability to pathologic bereavement

51
Q

3 complicated bereavement reatcions

A

Absent
Delayed
Chronic

52
Q

Lindeman 5 subgroups of grief symptoms

A 
Somatic distress
preoccupation with images 
Guilt
Hostility
Meaningless activity
53
Q

7 Key transition points in holistic assesment of cancer patinets

A 
diagnosis
beginning of treatment 
completion of primary treatment 
Each new episode of disease
Recognition of incurability
Beginning of end of life
Dying is imminent
54
Q

emotional thermometer

A

Distress, anxiety, depression , anger and help wanted

55
Q

6 sources for bereavement management

A 
Written info 
Primary care team 
Specialist bereavement services
Hospital based services
Funeral directors
Volunteers
56
Q

Fiduciary

A

Professional relationship built on trust

57
Q

Double effect doctrine

A

Recognition that bad consequences are possible in doing good –>
Original action is good
Sole intention of the act is good
Good effect is not produced as a consequence of bad effect
Required outcome is significant enough to warrant risk

58
Q

4 prima facie principles

A

Autonomy
Beneficence
non- maleficence
justice

59
Q

Distributive justice

A

Fair spread of scarce resources

60
Q

Deontology

A

Good means doing the right thing regardless of outcome. Duty ethics–> some acts are just wrong

61
Q

Consequentialism

A

Cost-benefit analysis of likely outcome. Good action produces best result for the most people, produces the most benefit despite intentions

62
Q

Morality

A

Absolute values vs moral relativism

63
Q

Kolva study amount of people who were seriously impaired in at least one capacity

A

1/3

highest rates in understanding and reasoning

64
Q

MacCat capacity

A

Significantly associated with cognitive funstion and education, not with anxiety or depression

65
Q

% who have not heard of ACP

A

86%

66
Q

Fowler and Hammer results

A

10-15% treated in ICU during final admission
12% wanted life prolonging tretaments
48% had an ACP

Palliative and EOLC (2 decks)

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