Terminal Care Flashcards
What is meant when a patient is “approaching the end of life”
Likely to die within the next 12 months
What is Advance Care Planning?
Discussion with patients and those important to them about their wishes and thoughts for the future. This allows care to be delivered to meet their needs. It also allows patients to live and die in the place and the manner of their choosing.
Describe three elements of advance care planning?
Advance statement of wishes
Advance decision to refuse treatment
Lasting power of attorney for health and welfare
What is an advance statement of wishes?
Written statement setting down preferences, wishes, beliefs and values regarding care. Not legally binding.
What is an advance decision to refuse treatment?
Decision to refuse a specific type of treatment if you lose capacity. Legally binding.
What is a lasting power of attorney for health and welfare?
Giving someone the power to make decisions about health and welfare if capacity is lost.
What is ReSPECT?
A form that includes the Recommended Summary Plan for Emergency Care and Treatment. Personalised recommendations for future emergencies. It involves the patient’s preference and clinical judgement
What should be considered when deciding if a person is dying?
Reduced level of functioning. Progressive or irreversible organ damage
Ineffective treatments or interventions
Subjective opinion of patient/significant others of dying
What are some signs associated with dying?
Weight loss and poor appetite. Fatigue and increased time sleeping Reduced mobility Worse performance status and needs more help with ADLs Social withdrawal Change in consciousness Struggling with medication Cardiovascular changes Respiratory changes
Are these REVERSIBLE? Are these IATROGENIC?
What cardiovascular changes may indicate someone is dying?
Reduced pulse strength. Pallor and mottled skin in peripheries
What respiratory changes may indicate someone is dying?
Laboured breathing. Noisy secretions. Apnoeic episodes and Cheyne-Stokes breathing
What are the five priorities of care of the dying?
1) RECOGNITION of dying
2) Sensitive COMMUNICATION
3) Patient and important people INVOLVED in decisions
4) PEOPLE IMPORTANT TO DYING PERSON and listened to
5) Care tailored to INDIVIDUAL and delivered with COMPASSION
What framework can be used to inform a patient (and important people) that they are dying?
SBAR
S- identify yourself, describe how patient is doing today
B- what brought into hospital/interventions/progress/response
A- Because of what has been discussed, believe patient is dying in next hours-days (estimate)
R- Individualised plan of care e.g. interventions that will/wont be done, DNACPR, Pre-emptive prescribing, spiritual needs.
Questions/discuss?
What are 5 key symptoms of a person dying?
Pain, breathlessness, respiratory secretions, N&V, distress/agitation/delirium
What is pre-emptive prescribing?
Prescribing drugs in anticipation that a patient will experience the 5 key symptoms in the last few days of life (or high risk of deteriorating suddenly)
