Palliative Care Flashcards
What are the three truths about dying?
- we dont really mind death
- our biggest loss is emotional
- our biggest hope is spiritual
Why are we afraid of death?
- in the last 100 years we have quarintiened death
- people are now taken to a hospital and a sheet placed over them when they die and then to make sure they are gone they are cremated
Why is death good?
- when people get old they lose all function and cannot live by themselves and thus are misserable
What are the ECOG ratings?
0 = fully active 1 = restricted in physically strenuous activity 2 = self care but only for 50% of day 3 = limited self care for less then 50% of the day 4 = completely disabled 5 = dead
What happens in the last week of life?
- weakness and fatigue
- lack of appetite
- lack of interest in surroundings
- pain
- restlessness and confusion
What happens in the last hours of life?
- all die of circulatory failure
- brain, kidney, liver and skin
- the end is more distressing for the family than the patient
Define death?
- abscence of life
What is medical death?
- absent pupil reflex
- no pulse, respiration
- no brain activity
What are the considerations of the person?
- social
- ethical
- health
- financial
- personal
- other
Define palliative care
- to cure sometimes, to relieve often, to comfort always
- easing the severity of pain associated with disease or illness without removing the cause
What are some factos associated with pallliatice care?
- affirms life and treats dying as a normal proccess
- neither hastens nor postpones death
- provides relief from pain and other distressing symptoms
What does palliative care integrate?
- physical, psychological, social, emotional and spiritual aspects of care with coordinated assessment and management of each person’ needs
What are the generalised effects of cancer?
- weakness
- fatigue
- weight loss
- increasing pain
What are the specific effects of cancer?
- pain
- bleeding
- swelling
- blockage
- metabilc e.g. raised calcium
- mass effects
- fungating wound
What are the effects of morphine?
- drawsiness and impaired concentration
- constipation
- nausea and vomitting
What is temporal effects?
- patient feels fine now but later on feeling severly worse
What are other factors to consider in palliative patient care?
- prognosis
- bucket list
- advanced directives
- financial planning
- special events
- funeral planning
What is the role of RT in palliative care?
- make you feel better but RT can make you feel worse first
- need to think about patient shouldn’t just treat for the sake of treating
What are the aspects to decide if RT is used for palliative patient?
- will RT help
- prognosis (if patient is going to die tomorrow then dont treat)
- patient factors
- alternatives (e.g. is a stent possible instead of 10 days of RT)
- timing
- dose fractionation
What are some indications of SC compression?
- pain increasing
- weakness
- bladder and bowel dysfunction
What is the RT role in SC compression?
- 1 to 10 days
- 80:20 rule
- side effects: nausea and fatigue
What happens in an emergency SC compression?
- rapid onset of symptoms leading to irreversible paralyss
- early intervention allows for preservation of neruological function in up to 80% of people
- reduces pain
What is the managmenet of an emergency SC compression?
- steroids
- emergency RT to 30Gy in 10 fractions
- pain management
What are the challenges in treating CNS?
PHYSICAL
- pain, confusion, immobility, neurological, other cancer effects (steroids, morphine)
EMOTIONAL
- drug effects, depression, cycle of loss, anger, fear
SPIRITUAL
- faith or lack of faith, miracles
PRACTICAL
- mask, timing of treatment, family, conflicitng interests, swelling from steriods
What are the beam arrangment options for spine RT?
- ant and post
- 2 post oblique, 1 lat, 1 ant oblique and 1 ant
What are the common side effects from RT and how are they treated?
- nausea: zofran
- diarhhoae: gastro-stop
- burning: skin lotion
- muscositis: opioids
- hair loss: none
- fatigue: none
- oesophagitus: mylanta
How do we manage palliative patients?
- empathy
- allow space
- understand journey: changes will occur
- faimly members are also experiencing loss so may be part of care process
What are the emotions realted to dying?
- fear
- guilt
- loss and grief
- hope
What are the three factors that make up the “whole person”
- physical
- spiritual
- emotional
What are the 5 stages of emotion?
- fear
- anxiety
- guilt
- loss and grief
- hope
