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Health and Society Year 4 > Palliative Care > Flashcards

Palliative Care Flashcards

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1
Q

Define palliative care

A

Active holistic care of patients with advanced, progressive illness

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2
Q

Goal of palliative care

A

Best QOL for patients and familities

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3
Q

Aims of palliative care

A

regard dying as normal process, relief from symptoms, integrate psychological/spiritual aspects, ensure live as fulfilled as possible until death, bereavement service

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4
Q

What does palliative care involve

A

self help, information giving, psych/social support, symptom control, bereavement care

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5
Q

Difference between end of life care and end of life care pathway

A

end of life care (last year)

end of life care pathway: last 48h of life

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6
Q

2 provisions of palliative care services

A 
voluntary sector (marie curie, macmillan)
hospices (day unit, hospice at home)
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7
Q

4 types of nurses

A

District nurse: community based, generic skills, hands on
Practice nurse: practice based, general palliative care
Marie curie: community based, district nurse for palliative care/ terminal illness
Macmillan: community/hospital, cancer.

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8
Q

General criteria for referral to specialist palliative care team

A

Incurable disease or refused treatment if competent to do so

Prognosis < year

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9
Q

Indications for palliative care where prognosis might be more than 1 year

A

> year but have complex needs

need support around dx of incurable disease (may be longer than a year)

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10
Q

6 general indicators for palliative care

A
  • progressive deterioration
  • dependence in >/=3 of ADL
  • multiple comorbidities
  • symptoms cannot be alleviated
  • malnutrition signs (cachexia/ < albumin)
  • severe progression of illness over recent month
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11
Q

3 inappropriate referrals for palliative care

A
  • chronic stable disease or disability with life expectancy of several years
  • chronic pain not with progressive terminal disease
  • problems are psychological
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12
Q

Gold standard framework for palliative care

A

Tasks: communicate, coordinate, control symptoms, continuity, continue learning, carer support, care in dying phase.
Helps primary care, care homes, end of life support.

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13
Q

10 points from the end of life care strategy 2008

A

Raising the profile (engage with local communities)
Strategic commissioning (equality impact assessments for changes in service)
Identifying people approaching end of life
Care planning (needs assessed, wishes etc)
Coordination of care
Rapid access to care if condition changes
Last days of life and care after death
Involving carers
Measurement and research
Funding

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14
Q

9 principles from the WHO Palliative Care

A 
FANS (family, activity, natural death, symptom relief) 
Symptom relief
Affirm life and regard dying as normal process
Natural death (doesn’t hasten/ prolong)
Spiritual
Actively as possible until death
Family through illness and bereavement
Team approach to patient and family
Quality of life and course of illness
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15
Q

3 Gold standard framework for the provision of palliative care

A

Improve quality of care
Improve coordination and collaboration
Improve outcomes that matter to people (unwanted crises, choosing placing of death)

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16
Q

7 signs/symptoms a person exhibits in the last days of life

A

agitation, Cheyne-Stokes breathing, deterioration in consciousness, mottling skin, weight loss, fatigue

17
Q

Psychosocial needs in the last few days of life

A

Persons goals and wishes

Views of those important to the person about future care

18
Q

What do you need to communicate with the family? (3)

A
  • Needs and expectations
  • Discuss prognosis
  • Shared decision making
19
Q

What do you need to take into account when treating the dying?

A

take into account culture/ spiritual/ religious beliefs and advance directive

20
Q

3 things when maintaining hydration

A
  • swallowing difficulties
  • risk of pulmonary oedema
  • monitor every 12h for changes in symptoms
21
Q

Treatment of anxiety, delirium and agitation

A

explore cause (reversible causes e.g. electrolyte disturbance)

  • non-pharmacological
  • trial BZD for anxiety/ agitation
  • antipsychotics for delirium or agitation
22
Q

What do you need to assess when anticipatory prescribing?

A

Assess what they may need in last days of life (anxiety, breathless, N+V, pain) account for:

  • likelihood of symptoms occurring
  • benefits: harms, risk of deterioration
  • monitor for benefits and side effects daily
23
Q

Define bad news

A

Any news that drastically and negatively alters patients or their relatives views of his/ her future. Causes cognitive, behavioral, emotional deficit in person receiving the news that persists some time after news ins received.

24
Q

8 difficulties when breaking bad news

A 
Personality types
Gender
Culture
Upsetting someone
Burden of responsibility
Uncertain of patients expectations/ hope
Own inadequacy
Embarrassment for too optimistic picture for patient
25
Q

Define SPIKES

A

Setting up (time, privacy, no interruptions, mentally rehearse)
Perception (understanding situation)
Invitation (permission/ ask in advance about sensitive topic)
Knowledge (what you want to convey)
Emotions (empathy)
Strategy and summary

26
Q

Stages in Colin Murray Parkes’ four pahses of grief

A

numbness, yearning/anger, disorganization/despair, re-organization

27
Q

Warden’s tasks of mourning

A

accept reality of loss, work through pain of grief, adjust to environment where deceased is missing, emotionally relocate deceased to move on with life

28
Q

5 reasons for pathological grief

A 
extended grief reaction
stuck
mummification
denial
major depressive > 2 months after loss
29
Q

6 factors affecting grief sensitivity

A

Obvious: meaningfulness of relationship, manner of death, age of griever
Non-obvious: individual resilience, attachment and dependency, religious beliefs

30
Q

3 impacts of religious beliefs on bereavement

A

Afterlife (possibility of meeting up again)
Continued attachment (prayer as means of continuing connection)
Religious funeral rituals that aid and progress the grief process/ recruit social support

Health and Society Year 4 (9 decks)

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