Palliative Care

Question 1

Life-limiting conditions - define

Answer 1

Any illness/condition where it is expected that death will be a direct consequence.
1. Curative treatment fails - e.g. cancer, organ failure.
2.Premature death is inevitable but life-prolonging treatment options - e.g. CF.
3. Progressive and no treatment options - e.g. MS, MND.
4. Non-progressive but irreversible causing severe disability - e.g. cerebral palsy.

Question 2

Palliative care - define

Answer 2

A holistic approach to caring for patients with LLCs and their families that encompasses developmental, physical, emotional, social and spiritual aspects. The focus is on promoting quality of life by managing distressing symptoms, providing respite care, transitioning to EOL care and support during bereavement.

Question 3

Paediatric factors

Answer 3

1. Different spectrum of illnesses
2. Smaller and more diverse pt population
3. Parental involvement as caregivers and decision-makers
4. Developmental factors affecting pt’s understanding and decision-making capacity
5. Different physiology and pharmacokinetics
6. Different manifestation and trajectory of grief in parents
7. Need to consider needs of siblings and other relatives

Question 4

Essential components

Answer 4

1. Individual care plan and frequent re-assessment/re-evaluation f needs
2. Key worker coordinates care
3. Involvement of expert paediatrician and local clinicians/nurses with experience in PPC
4. 24-7 support for families and regular respite care
5. Emotional support for parents/families including during bereavement
6. Provision of medication, aids, housing adaptions, equipment and financial support

Question 5

Cystic fibrosis

Answer 5

Genetic multi-system disorder involving the hyper-production of thickened mucous (esp. in lungs and bowels).
S/S
- Lungs - productive cough, decreased pulmonary function, activity intolerance, fatigue, increased WOB, barrel chest, clubbing.
- Bowels - pain/cramping, weight loss, muscle wasting, frequent greasy/bulky stools or constipation.

Question 6

Cystic fibrosis - management

Answer 6

1. Positioning - semi-Fowler’s
2. Oxygen - humidified, titrate > 90% (AVOID high concentration), nebulised hypertonic saline.
3. Medications - bronchodilators, mucolytics, ABs.
4. Chest physiotherapy - airway clearance therapy, postural drainage.
5. Nutrition - high-fibre, high-protein, high-calorie, fat-soluble vitamins, pancreatic enzymes.
6. Hydration
7. Rest
   *Lung transplant