Palliative Flashcards
What is palliative care?
What is the goal?
Care for those with serious illnesses that is aimed at relief of symptoms and stress
The goal is to improve quality of life
Who palliative care appropriate for?
It is appropriate at any age and stage with a serious illness
T/F
Palliative care cannot be provided with other medical treatment
False. You can receive palliative care and still receive medical treatment for your disease.
What are 3 things that make something a serious illness?
1) Impacts Activities of Daily Living
2) Has effect on quality of life
3) It affects the time someone has to live
Top 5 leadings causes of death
And explain the stats
1) heart disease
2) cancer
3) unintentional injuries ; notice this one isn’t chronic
4) chronic lower respiratory disease
5) cerebrovascular disease
About 60% of adults live with one of these.
Then 40% have two or more.
“Medical advances have led to culture of cure”.
What does this mean?
What is the truth?
It means people expect to be cured due to all the new medicine and technology we have.
Patients do not die.. they code.
The truth is we don’t have a cure for everything. What we have is a lot of ways to prolong life with these illnesses.
What is an accurate way for practitioners/patients to decide if palliative care should be considered?
Whether or not they would be surprised if the patient died in the next year.
Main four trajectories of dying?
1) Sudden death
2) Terminal Illnesses
3) Organ Failure
4) Frailty
Examples of sudden death
Care accident
- the point is, we don’t expect this one.
10%
Examples of organ failure
What is the nature and how is this a problem?
Where do these people usually stay for their care?
HF, COPD, ESRD, etc.
Very common. The nature is that they have exacerbations and each time, they slowly move closer to death. This can be confusing for family bc they will never recover & they think they’ll continue to survive but this isn’t possible.
Those with organ failure are often found in nursing homes
- but the cost is an issue
- they can still end up in the hospital
When does palliative care want to get involved with organ failure cases?
For organ failure, palliative care wants to begin way back on the start of the exacerbations. Because remember, you can still be on palliative care and get treatment. Their focus is building that relationship.
Example of terminal illness trajectory
Pancreatic cancer for example. The outcome is pretty certain upon diagnosis and is predictable.
Example of frailty trajectory
Dementia… When elderly just survive long enough to die of being frail/age.
Burden of serious/chronic illnesses
- Multiple co-morbidities are often present
- Patient’s symptoms cause discomfort
- It ruins quality of life
- It becomes hard for family and caregiver to provide
- It is expensive
Patient quality care checklist?
A sense of control Spiritual peace Finances & affairs in order Strong relationships with loved ones Believing their life has meaning
Healthcare team quality checklist?
Symptom management
Emotional comfort
What aspect of nursing causes higher patient satisfaction?
When they believe the nurse did everything to help
What are ALL of the jobs of palliative care?
Manage symptoms and pain Communicate about goals of care Advance care planning Provide support Assist with coordinating and transitioning care
T/F
Palliative care is more expensive
False. Decreased hospital visits, ICU admissions, and ED visits
T/F
Unfortunately with palliative care, patients have decreased length of life
False.
Patients actually live longer
Who needs palliative care?
Frequent hospital admissions Symptoms that are hard to manage Complex care Decline in function or weight Uncertainty about care How long they have left to live
How are hospice and palliative care related?
All hospice is palliative but not all palliative care is hospice
When is do we switch over to hospice?
Switch to hospice with there’s no point in doing curative treatments. With palliative care, you can simultaneously do curative therapies.
- To do this, the physician and patient need to be on the same page. If you stop care, then you really do stop (unless there’s a good reason)
Prognosis for hospice?
6 months or less
- continuous evaluation is done to make sure they meet standards.
- sometimes they can graduate
How is hospice paid for?
Medicare
Medicaid
Third party insurance
Avg length of stay on hospice?
2 weeks - the point is people tend to wait till the last minute
What was the old model like when it came to end of life care?
The medical team tx the issue for as long as possible and then dumped them on hospice/end of life care.
- Now, we want to introduce that end of life care earlier so there’s no feeling of abandonment.
- “REFCOCUS”
What is a TPOPP form?
What are the sections?
TPOPP stands for Transportation Physicians Orders for Patient Preferences
- it is a document that states the patients wishes and moves with the patient throughout health care
Sections:
- Resuscitation (DNR or full code)
- Medical Interventional (still has a pulse but has rapid health deterioration)
- Nutrition
- Signatures
