Palliative care Flashcards
1
Q
What is palliative care?
A
active, total care of the patients whose disease is not responsive to curative treatment
*patients are referred to palliative care if patient is symptomatic and assistance needed to manage this
2
Q
what are some conditions that might require palliative care?
A
- advanced cancer
- end stage heart failure
- renal failure and stopping dialysis
- surgical emergencies in which the patient is not fit for an operation
- bowel ischaemia, bowel obstruction, perforation, advanced peripheral vascular disease
- end-stage chronic obstructive pulmonary disease
- neurodegenerative conditions
3
Q
what are the roles of the palliative team?
A
- maintain comfort, increase QOL
- alleviate negative sx
- communicate with patients and families about EOL care
- explore patients requests
- prescribe anticipatory meds
4
Q
who is involved in the palliative care team?
A
- palliative specialist doctors and nurses
- GP, district nurses, physio
- social care
- chaplains, complementary therapists
- dieticians
- psychologists
5
Q
what affects the trajectory of decline?
A
- their condition and how aggressive it is
- their previous functional reserve - pre-morbidly
- how actively they are being treated for their medical condition
6
Q
what are some general indicators of decline?
A
- unplanned hospital admissions
- performance status is poor or deteriorating
- dependent on others for care
- carer needs more help and support
- significant weight loss
- persistent symptoms despite optimal treatment
- a decisions to reduce, stop or not have treatment
7
Q
what are some signs that may suggest a patient maybe approaching the EOL?
A
- sleeping for over 50% of day
- tiredness
- E+D less
- Cheyne-stokes respiratory pattern
- shallow breathing
- use of accessory muscles of respiration
- skin colour changes
- agitation
- decrease urine output or incontinence
- difficulty swallowing
8
Q
what is “anticipatory prescribing”?
A
when approaching EOL people may experience pain, nausea, agitation, delirium, anxiety, secretions etc
- medications to relieve these sx
9
Q
what are some examples of such anticipatory medications?
A
- pain -> morphine SC or syringe driver
- anxiety -> midazolam
- N+V -> Levomepromazine
- secretions -> Hyoscine hydrobromide
- agitation -> haloperidol
- SOB -> oxygen or morphine
10
Q
what is the process after death?
A
- confirming death - verifying
- paperwork
- medical certificate of cause of death completed (unless coroner)
- coroners referral form
- cremation form
