Palliative Care / End of Life Flashcards
Hospice - Definition
Specialized form of palliative care focused on end of life care; dependent on likely prognosis < 6 months
Focuses on quality of life in the dying patient; receiving hospice care may in fact increase survival times but pursual of curative / disease-modifying therapies is not within the scope of hospice care
Palliative Care - Definition
Specialized medical care for people with serious illnesses; offered independent of prognosis and often delivered hand-in-hand with disease-modifying treatment
Scope includes basic management of symptoms, pain, depression, and anxiety as well as discussions about prognosis, goals of treatment, and suffering
Palliative care “fills in the ____”
GAPS:
Goals of care
Advance Directives
Psychosocial / spiritual support
Symptom control
Physiologic changes - days to weeks before death
Social isolation Less need for food Increased time sleeping Decreased sensory perception Loss of control of bowel / bladder
Terminal delirium
Occurs hours - days - weeks before death; unlike “normal” delirium, NOT reversible
Treatment generally consists of education and support of family but signs of pain (facial grimacing) indicate trial of opioids
Neuroleptics (haloperidol, chlorpromazine) may be used cautiously in severe cases
Physiological changes - Hours before death
Decreased blood pressure
Variable pulse - may increase or decrease
Body temperature fluctuation - fever common
Skin color changes - flushed, blue, or pale
Breathing variable - may increase, decrease, or become irregular; apneic periods common
Congestion
Coma
Management of respiration around the time of death
Best management is to re-position, discontinue IV fluids; consider anti-cholinergics (sub-lingual Atropine) for secretions or opioids for dyspnea
No need for suction or oxygen
Requirements for pronouncement of death
Non-responsiveness
Absence of respirations and heartbeat
Absence of cranial reflexes (no corneal reflex, pupils are fixed)
