Palliative care Flashcards
Palliative care
Improves the quality of life of patients and their families facing the problems associated with life-threatening illness
via prevention and relief of suffering
Aims of palliative
Information for the person and their carers, with ‘signposting’ to relevant services.
Provides relief from pain and other distressing symptoms
Offers a support system to help patients live as actively as possible until death
Integrates the psychological and spiritual aspects of patient care
End of life
Not surprised if this patient were to die in the next 6 to 12 months
Mx
- Discuss prognosis
- Symptom control
- Stop unnecessary medication
- Maintain hydration
Advanced care plan
Anticipated care needs including preferences for symptom management, any identified needs for care after death, and any identified resource needs.
Preferred care setting
Realistic personal goals (including treatment and resuscitation) and wishes
Constipation
Senna - stimulant laxative
+ lactulose - osmotic laxative
Soft loading: bisacodyl suppositor or sodium citrate.
Hard loading: glycerol suppository such as lubricant or stimulant.
Very hard loading: arachis oil enema
Cough
Weak opioid cough suppressant - pholcodine linctus
Treatment of the underlying cause
Use of oral corticosteroids
Breathlessness
Room cool, improve air circulation and encourage relaxation and breathing techniques.
Bronchodilator
Oxygen - hypoxic
Oral morphine
Benzodiazepine
Oral
Dry mouth - cold water or ice and vaseline for lips
Pain - non-opioid analgesia
Candida:
immunocompetent - oral nystatin
Immunocompromised - fluconazole
Aphthous ulcers - topical corticosteroids - hydrocortisone lozenges or Beclometasone spray
or doxycycline mouthwash - severe
Pain
NSAIDs
Opiods
Pregabalin
Gabapentin
Secretions
Positioning
Medication:
Hyoscine hydrobromide
Atropine
Consider single dose of a broad spectrum antibiotic
How to administer symptom relief
Syringe driver
Considerations during end of life
- Whether the person would like someone important to them to be present
- Person’s current level of understanding about nearing death
- Person’s cognitive status
- How much information the person would like to have about their prognosis
- dying person’s cultural, religious, social, or spiritual needs or preferences
Anxiety
Benzodiazepines
RESPECT form
Emergency care treatment plan:
- diagnosis and circumstance
- documents
- values
- fears and wishes to avoid
- priorities
- DNR
