Physiology of dying

Question 1

DETERIRORATION PHASE

i) what tool is used to assess unmet palliative care needs?
ii) what does a score of two or more indicate
iii) name three things that are seen in the last weeks of life

Answer 1

i) SPICT tool

ii) 2 or more general indicator > population risk of dying within 12 months
- unplanned hosp admission
- performance status deteriroration
- depend on other for care, progressive weight loss, symptoms despite optimal treatment

iii) increasingly sleepy, mobility declines, swallow deterirrates, appetite reduces, cognitive change, think they are starting to die

Question 2

ACTIVELY DYING - NEUROLOGICAL SYSTEM

i) what type of delirium may be seen? what concious level?
ii) what change in breathing may be seen?
iii) what three things can be reduced
iv) name five neuromuscular changes that may be seen
v) what can be given to stop excess secretions

Answer 2

i) hypoactive delirium and reduced conc level

ii) cheyne stokes or apnoea
- CS respiration > crescendo decrescendo pattern of breathing

iii) reduced pupil responses, reduced response to verbal stimuli

iv) neuromusc relaxation
- build up of secretions (rattle), breathing with mandibular movement, neck hyperextension, inability to swallow, inability to close eyelids

v) anti cholinergics

Question 3

CARDIOVASCULAR SYSTEM IN DYING

i) what BP is seen?
ii) what changes in elec heart activity may be seen?
iii) how may reduced organ perfusion manifest? (2)

Answer 3

i) reduced BP - hard to palpate pulses
ii) varied change in elec activity of the heart
iii) decreased urine output and skin mottling - usually late signs

Question 4

what are the five priorities for care of the dying person

what are obs checked against?

Answer 4

recognise

communicate

involve - the dying person and family in the decision making and care

support - psych, spiritual, social needs

plan and do - individualised care plan

• obs checked against a persons comfort