palliative finals Flashcards
Concerns regarding nutrition and hydration
- distress to patient & family (am i/is my loved one dying?)
- makes patient & family believe medical team has ‘given up’
reason for reduced oral intake
systems shutting down > reduced metabolic demands > decreased need for food > lack of appetite
how to manage family’s expectations when patient has reduced oral intake (3)
- patient looks comfortable, suggests they do not need food
- explain dying process (reduced metabolic demands)
- feeding doesnt prevent inevitable, instead hastens death (aspiration pneumonia, third spacing, pleural effusion)
how to assess family’s acceptance (4)
- look for strongest member, get them to explain
- examine understanding of condition
- stages of grief
- explain dying process
how to empower family at EOL (5)
- pleasure feeding
- bicarb swab stick w juice/flavouring
- oral hygiene (cotton balls to wet lips, soft white paraffin) –> pre emptively prepare patient before family comes
considerations when planning care for patient at home (5)
care at home:
1. suitable caregiver able to commit full time/cope
2. caregiver in distress?
3. how to support caregiver: interim care, private nursing home, respite care
institutional care:
4. due to patient factors (high symptom demands)
5. compassionate discharge for death at home
EOL symptoms
R(3), N(2), C(3), G(3), U(1)
Respiratory:
1. reduced lung function
2. pleural effusion > decreased RR (cheyne stokes)
3. “noisy” (terminal secretions)
neurological:
1. GCS drop (touch/voice response)
2. delirium (hyperactive to hypoactive)
cardiovascular:
1. decreased CO (decrease HR, BP, capillary refill)
2. third spacing (oedematous)
3. mottled feet
gastrointestinal:
1. LOA
2. cachexia
3. constipation (poor intake, low GI motility)
urinary:
1. decreased urine output (kidney failure, reduced intake)
global function:
- ecog 4
- activity intolerance
role of nurses in bereavement care (4)
- explore fam’s ability to cope with death
(psych: type of death. financially:breadwinner?. acknowledge stages of grief) - offer listening ear: active listening
- provide resources: list of undertakers ect, practical support
- involve MDT
intervention for acute pain crisis (5)
- call for help (you notify doc, colleague accompany pt) > IMMEDIATE attention
- rapid opioid titration via IV access (3-way tap) or SC (thrombosed vein, unable to obtain iv access)
- dose: 1-2.5mg morphine/10-25mcg fentanyl
- stop after obvious relief (behavioural pain assessment)
- start continuous SC till pain is well-controlled
opioid dose for acute pain crisis:
morphine 1-2.5mg
fentanyl 10-25mg
what is breathlessness at end of life
- subjective, not related to SpO2
- CHEYNE STOKES BREATHING PATTERN
breathlessness interventions (3)
- opioids, steroids, anticholinergics, anxiolytics
- continuous cocktail infusion, pre-emptive dose
- environment (fan, ventilated), chest physio, paced activities
stridor management (5)
- surgical (trachy)
- palliative chemo
- radiotherapy
- steroids (dexamethasone), opioids for SOB, sedation (midazolam)
- reposition for comfort
symptoms of superior vena cava obstruction
- gradual onset
- pemberton’s sign: face becomes more cyanosed on raising arms
SVCA management (4)
- nurse patient in an upright position, no BP over upper limbs
- supplementary O2 & fan
- stat IV dexamethasone
- radiotherapy
- ICU/HD for continuous monitoring
