Palliative

Question 1

What is the medical treatment + planning + decisions act 2016

Answer 1

Framework for decision making that is only applied when a person does not have capacity to make treatment decisions for themselves

Question 2

What is palliative care?

Answer 2

An approach that improves the quality of life of pt + families facing problems associated with life threatening illness through prevention + relief of suffering
Provides multi-disciplinary care, education for family
Involves positive attitude to death, open discussion

Question 3

What are the elements of palliative care?

Answer 3

Responsive to the need, preferences + values of people, families + carers
Person centred
Family centred
Effective communication
Shared decision making
Personal autonomy

Question 4

Community based palliative care

Answer 4

Peoples homes, aged care, correctional facilities

Question 5

Hospital based palliative care

Answer 5

Inpatient palliative care beds, Ed

Question 6

Define grief

Answer 6

Personal response to a loss

Question 7

Define bereavement

Answer 7

The period after a loss

Question 8

Define mourning

Answer 8

Outward + active expression of grief

Question 9

Describe the role of the health professional in coping with death

Answer 9

To educate grieving families about the bereavement process + help them accept the intensity of grief will subside with time

Question 10

What are key theories of coping with death

Answer 10

Stage model → Elizabeth Kubler- Ross (1969)
Task model → William Worden
Stressor specific - model → Margaret strobe + Henk Schut (1996,1999)

Question 11

Stage model - Elizabeth Kubler‐Ross
(1969)

Answer 11

5 stages - denial, anger, bargaining, depression + acceptance

Question 12

Task model - William Worden

Answer 12

4 tasks to make an adjustment to their loss - accept reality of loss, work through pain + grief, adjust to life without the deceased, relocate the deceased

Question 13

Dual process model
Stressor specific model - Margaret Strobe & Henk Schut (1995, 1999

Answer 13

Dual process model
Accepts that grief can be both helpful + detrimental depending on the circumstances
Expressing + controlling feelings are important + oscillation between coping behaviours is perfectly acceptable as grief is a dynamic process where focus can shift from loss orientated or restoration orientated

Question 14

What is an advanced care directive?

Answer 14

Outlines your preferences for future care along with a persons beliefs, values + goals
Ability to appoint a substitute decision maker for when a person does not have the capacity to make decisions
It helps everyone know what you would want if you cannot tell her

Question 15

What is the National palliative Care standards 5th Ed 2018?

Answer 15

Guides the delivery of palliative care across settings from specialist palliative care providers to acute, aged care, primary care + other generalist services

Question 16

What is the National consensus statement: essential elements for safe + high quality end of life care (ACSQHC, 2015)

Answer 16

It outlines 10 elements related to both the approach to be taken + structures to support such an approach to facilitate safe + high quality end of life care

Question 17

What is the national palliative care strategy?

Answer 17

Describes the over- arching strategy by the Aus Government department of health on the delivery of palliative care in Aus

Question 18

What are the National palliative care standards?

Answer 18

Standard 1 → assessment of needs
Standard 2 → developing care plan
Standard 3 → caring for carers
Standard 4 → providing care
Standard 5 → transitions within + between services
Standard 6 → grief support
Standard 7 → service culture
Standard 8 → quality improvement
Standard 9 → staff qualifications + training

Question 19

What is the National standards assessment program (NSAP)?

Answer 19

A quality improvement program that specialist palliative care providers voluntary participate in to evaluate their services against other providers

Question 20

What are some oral symptoms in palliative + end of life care?

Answer 20

Xerostomia → dry, painful mouth (cause-antidepressants, anti histamines, anticholinergics, radiotherapy, limited oral intake) treat - mouth care, small sip water
Stomatitis → inflammation of mouth + lips ( cause - radiotherapy, chemo, nutritional deficits, infection)
Mucositis → inflammation of mucosa (cause - radiotherapy + chemo, treatment - mouth care)
Sialadentitis → inflammation of salivary glands, flow is inhibited due to dehydration
Candidiasis → fungal infection caused by yeast (candida) - treat nystatin 1ml topical
Mouth ulcers → mouth care

Question 21

What is the death rattle?

Answer 21

Combination of relaxation of the soft pallet and difficulty swallowing saliva / mucus

Question 22

What drugs can be used to reduce secretions ?

Answer 22

Glycopyrnonium bromide

Question 23

Drug treatments for nausea / vomiting

Answer 23

GIT induced → metoclopramide, domperidone
Chemoreceptor induced → haloperidol
Vestibular → stemetil
Intracranial → dexamethasone

Question 24

What is involved in the last days of life tool kit?

Answer 24

Last days of life play
Tookit guide to medications
Observation + symptom assessment chart
Care after death in hospital