SCA online - older adult, end of life Flashcards
Motor neuron disease
MND - rare condition that progressively damages the nervous system, leading to muscle weakness and wasting. - Eventually difficulty mobilising, swallowing and breathing.
Assisted dying
“The UK Legal framework does not permit assisted dying. Therefore, as a GP, I am unable to participate in or provide paperwork related to the process of assisted dying.”
Mx/
Listen, be empathetic, a lot of ICE
Explain that this is not lawful - an can not help
Discuss palliative care (what you can do to support)
Carer stress
Fx/
- Emotional burden
- Physical strain
- Neglect of personal health
- social isolation
- financial pressure
“i know you have come in regarding your mother’s health, may i ask how you are doing”
Mx/
Respite/ day care - for short term
ensure emergency care - neighbour, family
Support groups, build a social network
Encourage regular breaks and hobbies
Awareness of financial support for carers
Regular FU
DNAR discussion
Do not attempt cardiopulmonary resuscitation. If a person is to have a cardiac arrest, or dies, this document informs a healthcare professional will not perform CPR. This does not mean that we will not care for the patient, and other options eg abx may still be appropriate.
If the patient’s life comes to a natural end, then we will not attempt to reverse this.
You have explained that patient’s quality of life already is extremely poor, they are very unlikely to survive CPR. CPR is successful in less than 10% within the hospital, let alone in the community, of which the vast majority have a deterioration in quality of life.
Mx/
assess capacity to make a decision - although this is a medical decision, it is appropriate to discuss with patient. If no capacity DW NOK
Lewy Body dementia
Brain disorder that can lead to problems with memory and brain function, with problems with movement.
Fx/
fluctuation cognition
visual hallucinations, disturbed sleep
parkinsonism - rigidity, tremor, bradykinesia
Mx/
Bloods - RO delirium
Ensure safety - leaving cooker on, carers
Memory clinic
Community health wellbeing team - support patient and family
Managing challenging behaviour in Dementia for carers
Acknowledge this is the dementia and not the person, they are not acting like this on purpose.
Analogy of being in a foreign country - you are stressed and nobody speaks English, how would you like a stranger to act around you.
Mx/
Non medical - calm environment, low noise, dim lighting, no stimulus, calm voices, soft music
Causes of worsening behaviour - pain, toilet, confusion.
Do not take it personally
Shift focus to different activity
Ensure safety - call 999 or 111 if concerned
Carer support
Medication - Haloperidol, Risperidone
Palliative care request
1 - empathy
2 - any causes for deterioration? - need for hospital admission or F2F review
3 - explain want to manage symptoms > cure of illness
4 - Able to take orally? if not then sub cut medication
5 - District nurse review, OOHGP aware, palliative team involvement
6 - SR1 form to help with benefits funding
Polypharmacy
Multiple medications can lead to unwanted interactions.
For example, having a dinner part of 2-3 people is easy to manage and ensure everyone has a nice time. Similar to medications, each one has their own role. However, at a larger dinner party, as guest numbers increase, this is more difficult to manage, some guests may not get along, similarly with medications the more we have the high chance of interactions and unwanted side effects.
