Module 4.4 (Palliative Care) Flashcards
Definition of Palliative Care
“Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
Essenital elements of palliative care?
Affirms life and views dying as a natural/normal process of life
Neither hastens nor postpones death
Uses a team approach to address the
> psychological
> social
> spiritual
aspects of patient care
- Provides relief from distressing symptoms
- Offers support to help patients live as actively as possible until death
- Uses a team approach to support the patient & family during illness, death & bereavement
Who are the people included when considering palliative care?
People with a progressing life-limiting or life-threatening illness
Will include people with:
– metastatic cancer
– HIV/AIDS
– end-stage organ disease
– progressive degenerative neurological conditions
– older people dying as a consequence of the ageing process
>not dependent on medical diagnosis –> determined by a person’s needs
What can someone with palliative care “also have”?
People with a progressing life-limiting or life-threatening illness
Who also have:
- increasing disability
- frequent hospitalisation
- and/or decreasing benefit from therapies
>includes people of all ages from perinatal to the very elederly
Wha are some patterns of functional decline?
Sudden death
Malginant disease
Organ failure
Frailty
What does continuum of care encompass?
What is a palliative care approach?
Priumary health care –> primary care needs
> effectively meets their needs
Intermediate needs
>exacerbation of symptoms
>access to a specialist pallaitve care for advice
Complex needs
>requires more attention than primary caregivers can provide
>referral to specialist
What is specialist pallaitive care?
- symptoms that require specialist assessment/management … beyond capacity of the primary care team to manage optimally
- patient and/or their family has psychological, social or spiritual needs that require specialist assessment
- patient is dying and the primary care team requires additional support and/or advice
How to access specialist care?
Home
- Silver Chain Hospice Care Service
Residential Care Facility
- Metro Ambulatory Palliative Care Service
Hospital
- Consultancy Services
- FSH, KEMH, PMH, RHCS, RPH, SCGH, SJoG
Palliative Care Units/Hospices
- Bathesda, Glengary, Hollywood, Kalamunda, Murdoch
How to communicate to palliative care patients?
Important to:
Be respectful of the situation
Develop rapport and trust
Reduce stress and anxiety
Convey important information
Be comfortable talking about:
– decision making & care planning care for deteriorating health
– dying
Allow time
What are some thical considerations for palliative care?
- Most concerns centre around cause of death
- Hydration and feeding
- Cardiopulmonary resuscitation
- Requests for assistance to die
- Family concerned that medications causing deterioration
What does advance care planning mean?
Failure to talk about and plan for death is one of the msot significant obstacles to imprvoing the quality of dying
To meet our desire for better deaths
- be informed about the limits of health care
- importance of discussing our preferences for end-of-life care
- the development and implementation of Advanced Health Directives
What are the common physical symptoms in palliative care?
Fatigue
Pain
Dyspnoea
Nausea and vomiting
Constipation
Anorexia
What are the common psychological symptoms?
Emotional Distress
Anxiety
Depression
Confusion
What should be asssessed before treating the previous symptoms?
Evaluation of
- Contributing factors
- Characteristics of the symptoms (intensity, location, quality, temporal nature, frequency, and associated pattern of disability)
- The meaning of the symptom to the person (including beliefs about the symptom and the effect on the person’s physical, psychological, and social well-being)
- Actions that the person is taking to manage or cope with the symptom
Effective symptom management typically requires?
> 3 types of approach
An integrated approach
- multidimensional assessment and management
Target approach
- directed at specific casual pmechanisms and factors contributuing to the problem
Tailored approach
- suitable for individual circumstanses, beliefs and preferences
How is multimodal analgesia achieved in patients with palliative care needs? What are the medications used?
Multimodal analgesia = combined use of different classes of analgesics
Improve the effectiveness of pain relief
Reduction of dose of each analgesic medication and therefore intensity of any side effects
>anticonvulsants
>TCA
>distraction, relaxation, surgery, opioids, ketamine, massage, TENS, NSAIDS, corticosteroids, paracetamol
What are the general principles of pain relief?
By mouth
By the clock –> at fixed intervals
By the ladder
For the individual –> there are no standard doses of opioids
With attention to detail –> monitoring of effect and adverse effects
What is the mechanism for nausea and vomitting?
