palliative care Flashcards
Name 3 life-limiting conditions
Cancer
Dementia/frailty
Heart/vascular disease
Respiratory disease
Kidney disease - end stage
Liver disease - end stage
Neurological disease - motor neuron disease
Any condition /complications that are not revisable
What is End of Lifecare
‘Person and family-centred care provided for a person with an active, progressive, advanced disease, who has little or no prospect of cure and who is expected to die, and for whom the primary treatment goal is to optimise the quality of life.’
What are the five domains of Holistic care?
spiritual
cultural
emotional
physical - clinical symptoms: pain, fatigue,
social
What do you need to consider in terms of caring for the pts family?
Stressful
Emotionally/psychologically/Spiritually challenging
Need to be
- Informed
- Educated
- Supported
what does the SPICT tool stand for?
Supportive & palliative care indicators tool
who are part of the Multidisciplinary team caring for the pt
Physicians/Oncologists/Surgeons
Nurses
Palliative Care Team
Nuclear Medicine Specialists
Physio
OT
Social workers
Name the 2 communication frameworks that you can use when communicating with a palliative patient
Communication Frameworks:
- PREPARED
- SPIKES
what do you need to consider when communicating with a palliative patient
Continuous through the patient journey
Involve patient, Family, Loved ones
Needs to be
- Effective
- Efficient
What does the prepared framework stand for
P- prepare for the discussion
R- relate to the person
E- elicit preferences from patients/carers
P - provide information tailored to the person
A- aknowledge emotions/concerns
R- (foster) realistic hope
E- encourage questions and further discussion
D- documentation
What does the SPIKES framework stand for
S- setting up the conversation P- Assessing the persons pperception I- obtaining the persons invitation K- providing knowledge and information to the person E- recognising emotions S- Strategy and summary
When should the goals of care be set?
Begin soon after life-limiting illness
Goals of care are a way of beginning _____ planning process
advanced care
What elements should a palliative care plan involve (8)
Who participated in the plan
Contact details – coordinators of care
Clearly defined Goals & Responsibilities
Ongoing holistic assessment (5 domains)
Multidisciplinary involvement
Sharing/re-evaluation details
Links to the relevant documentation
Planning for expected evens/changes
Symptom Control - Pain Management
Stepwise Ladder Approach
Control of breakthrough pain
Symptom Control - Dyspnoea
Dyspnoea
Positioning
O2
Suctioning
Anticholinergic drugs – secretions
Symptom Control
Pain Management
Dyspnoea
Nausea/dehydration
Neuro deficits
-
What are the 6 standards of care for palliative care
1) Assessment of needs
2) Develop the care plan
3) Caring for the carers
4) Providing care
5) Transitions within and between services
6) Grief support
Caring for the Carers
Stressful
- Carer Support - Assessment
- Respite Care
- Spiritual support
Caring for the Carers (HCW)
End of life care
- Burnout
- Moral Distress
- Compassion fatigue
Pharmacological interventions for palliative care patients
- Analgesics
- Nausea and Vomiting
- Hydration therapy
- Anticholergic drugs
Anticholinergic drugs
Pharmacodynamics
- Blocks Transmission of acetylcholine throughout the body
- Relaxation of smooth muscle
- Drying up of secretions
- Used in end of life care for secretion management
Anticholinergic drugs
Pharmacokinetics
Poorly absorbed in the GI tract
Does not cross the blood brain barrier – no effect on CNS
Anticholinergic drugs
Indications
Adverse effects
Contraindications
Indications – Spasm of GI tract, renal spasm, secretion management in EOL care
Adverse effects – Urinary retention, dizziness, tachycardia
Contraindications – paralytic ileus, urinary retention, glaucoma
What is the stepwise ladder approach?
starting with no opioid analgesia to control pain before scaling up
eg. panadol - codeine - morphine
why are meds given subcut?
difficult to gain PVC access
gag reflex absent - cant give oral meds
