MODULE 3 chronically ill, the dying and hospice care Flashcards
Age related sensory changes:
Diminished hearing ◦ Impaired vision
Walang speech!
Age-related neurologic changes:
Reduced reaction time ◦ Cognitive Impairment
Difficulty in Communication with the Older Person may be due to
Age related sensory changes
Age-related neurologic changes
Hidden Psychosocial Issues
Medical Illnesses having Psychotic Features
Site the origin of impairment hearing loss for pure tones problems with difficult speech language problems problems in binaural listening hearing loss for speech problems localizing sounds
Site the origin of impairment
hearing loss for pure tones - Peripheral
problems with difficult speech - cortical
language problems - cortical
problems in binaural listening - brainstem
hearing loss for speech - peripheral
problems localizing sounds - brainstem
AGING is accompanied by a decline of
◦ the auditory threshold
◦ sound frequency discrimination
◦ localization of higher frequency sounds
◦ discrimination of high-frequency consonants
Ageing is accompanied by an increased sensitivity to
◦ background noise ◦ Loudness ◦ recruitmentll
Doctor Shopping
Shock and Denial:
concept of care whose goal is to maximize the quality of a patient’s life when the quantity of that life can no longer be increased
Hospice
the application of palliative care to the patient who is felt to have a terminal illness ‘’
Hospice
The degree to which denial is adaptive or maladaptive appears to depend whether a patient continues to obtain treatment while denying the prognosis.
Shock and Denial
negotiation
Bargaining
Affirms life and neither hastens nor postpones death
Hospice
withdrawal, psychomotor retardation, sleep disturbance, hopelessness, and suicidal ideation
Depression
Admission Criteria for hospice care
• Life-limiting illness, prognosis is 6 months or less if disease takes normal course • Live in service area • Consent to accept services
Recognizes dying as part of the normal process of living
Hospice
Patient become frustrated, irritable, and angry at being ill
Anger
expands traditional diseasemodel medical treatments to include the goals of enhancing quality of life for patients and family, optimizing function, helping with decision-making and providing opportunities for personal growth
Palliative care
Focuses on quality of life for individuals and their family caregivers
Hospice
Treatment that enhances comfort and improves the quality of an individual’s life during the last phase of life
Palliative Care
May represent patients’ desire for control in a situation in which they feel completely out of control
Anger
True or false.
All hospice patients receive palliative care, but not all palliative care patients are enrolled in hospice
True
Caused by activity in neural pathways in response to potentially tissue-damaging stimuli
Nociceptive Pain (Inflammatory)
Initiated or caused by primary lesion or dysfunction in the nervous system
Neuropathic Pain
The expected outcome is relief from distressing symptoms, the easing of pain, and/or enhancing the quality of life
Palliative Care
True or false
Oral administration is the most convenient and cost-effective route
True
applicable early in the course of illness, in conjunction with other therapies intended to prolong life.
Palliative Care
Rectal administration provides slower absorption but with little first-pass effect
True
patient and family centered care
Palliative care
Drugs that were renally cleared
Morphine and hydromorphone
Most commonly used opioid in terminal illness.
MORPHINE
Adverse effects: nausea, sedation, confusion, constipation
appropriate for all patients with serious illness
Palliative care
Preferred drug In patients with addiction history
Methadone
Help the pt eat even while anorexic by:
a) Knowing the pt’s preference b) Serving the food that the pt wants c) Offering small portions on a small plate d) Serving hot soup, ice cream and fruits e) Allowing someone to eat with the pt f) Giving supplemental vitamins and minerals
Only opioid administered topically via patch which releases opioid steadily for 72 hours
FENTANYL
Can cause confusion and delirium
Drug that is useful for nausea
Metoclopromide
What Causes Caregiver Burnout?
Role confusion Unrealistic expectations Lack of control Unreasonable demands
The goal of palliative care
to enhance quality of life through assiduous symptom management and attention to psychological, social and spiritual needs of the patient and family
Mmse grading
25-30 normal
21-24 mild
10-20 moderate
<10 severe
Focuses on quality of life and death, and views death as a natural part of life
Palliative care
• Focuses on quantity of life and prolonging of life
Curative care
