Palliative care and EOL Care

Question 1

Palliative care

Answer 1

Total care for patients that are likely to die within 12 months

Question 2

SPICT

Answer 2

Used to identify people at risk of deteriorating and dying with 1+ advanced, progressive conditions or a new life threatening illness

Question 3

General indicators of decline

Answer 3

• Unplanned hospital admissions
• Poor performance status or deteriorating
• Dependent on others for care
• Carer needs more help and support
• Significant weight loss
• Persistent synptoms despite optimal treatment
• A decision to reduce/stop treatment
• Bedbound
• Drowsiness and impaired cognition
• Difficulty taking oral medication
• Reduced food and fluid intake

Question 4

5 considerations for the dying patient

Answer 4

1. The possibility of death is communicated clearly
2. Sensitive communication
3. The dying person and loved ones are involved in the decision making
4. Needs of dying person and family are actively explored
5. Individual plan of care

Question 5

Signs of the dying phase

Answer 5

• Cheyne - Stokes respiratory pattern
• Shallow breathing
• Use of accessory muscles for breathing
• Respiratory secretions
• Skin colour changes
• Decreasing levels of consciousness leading to coma
• Agitation/ restlessness
• Decreased urine output/ incontinence
• Decreased/ absent oral intake
• Difficulty swallowing

Question 6

Anticipatory prescribing

Answer 6

Prescribing before symptoms

Question 7

What to prescribe for anticipatory pain

Answer 7

Morphine SC PRN

Question 8

What to prescribe for anticipatory nausea and vomiting

Answer 8

Levomepromazine SC PRN

Question 9

What to prescribe for anticipatory breathlessness

Answer 9

Morphine

Question 10

What to prescribe for anticipatory restlessness and agitation

Answer 10

Midazolam SC PRN

if delirium and psychosis - Levomepromazine

Question 11

What to prescribe for anticipatory respiratory tract secretions

Answer 11

Glycopyronium

Question 12

Hydration in EOL care

Answer 12

• offer mouth care
• assess daily rehydration status
• clinically assisted hydration

Question 13

Performance status scores

Answer 13

0 - normal

1 - Restricted strenuous activity

2 - Capable of self-care and up and about > 50% of the time. Unable to carry out work activities

3 - Limited self care, confined to bed > 50% of the time

4 - Bedridden

5 - Dead