WEEK 4 Palliative Care Nursing Flashcards
Identify the 3 legal aspects for the standards of palliative care in Australia
- The National Consensus Statement: Essential elements for safe and high quality end of life care
- The National Palliative Care Strategy
- The National Palliative Care Standards
Describe end of life care
Care that people recieve in the last months, weeks and days of their lives to ameliorate distress and grief for the person and their family
Identify 5 areas where palliative care is undertaken
Specialist palliative care units
Residential aged care
Community palliative care
Inpatient facilities
ED
Outline the role of the National Palliative Care Standards
Specifically guide practice and governance of specialist palliative care services and are formally evaluated through a quality improvement program (NSAP)
Identify the 9 National Palliative Care Standards
- Assessment of Needs
- Developing the Care Plan
- Caring for Carers
- Providing Care
- Transitions within and between services
- Grief support
- Service culture
- Quality improvement
- Staff qualifications and training
Identify the 3 aims of palliative care nursing
- To alleviate/control symptoms
- Support and reassurance of patient and relatives
- Maximising quality of life
Identify the 6 principles of symptom management
- Evaluation
- Explanation
- Discussion
- Individualised Treatment
- Monitoring
- Dose Escalation
Identify the 4 components of a comprehensive symptom assessment
- Talk in a reassuring manner
- Determine if it is a new symptom
- Identify level of discomfort/pain
- Assessment and reassessment
Identify 5 common symptoms of palliative care
Anorexia
Dyspnoea
Nausea/Vomiting
Dehydration
Disorientation/Fatigue
What is Xerostomia and how is it managed?
Dry mouth, managed by small frequent sips and general mouth care
What is stomatitis?
Inflammation of mouth and lips
What is mucositis?
Inflammation of buccal mucosa
What is Sialadenitis?
Inflammation of salivary glands
Describe the changes in breathing patterns in palliative care
Common, indicating decreased circulation to the internal organs. May be irregular, shallow or periods of no breaths for 5-30 seconds followed by a deep breath
What does the ‘moaning sound’ on exhalation in palliative care mean?
Not an indication of distress, sound of air passing over relaxed vocal cords
Describe congestion as palliative symptom and management
“Death rattle”. Gurgling sounds coming from the chest. Caused as the person is no longer able to cough/swallow so secretions build up in back of throat Elevate head and turn patient on to their side
Describe nausea and vomiting as a palliative symptom and management
Can result from disease itself, meds etc. Check if they are taking an antiemetic, check last BO, attempt to identify cause, ensure bag nearby
Describe fatigue as a palliative symptom and management
Related to lack of sleep, low o2 in blood, poor diet. Look for and manage reversible causes, encourage to practice energy conservation and minimise visitors
Describe Delirium as a palliative symptom and management
Potential causes Infection, meds, drug withdrawal. Routine assessment, be calming, ensure lo lo bed and falls mat, reassurance
Describe constipation as a palliative symptom and management
Caused by decreased fluid intake, poor diet. Encourage fluids, high fibre diets if possible, bowel chart, aperirents
Describe diarrhoea as a palliative symptom and management
Caused by obstruction, surgery, disease itself. Hydration, withhold laxatives and liaise with medical staff
Describe pruritis as a palliative symptom and management
Often cause cannot be treated. antihistamines may be effective, encourage loose fitting clothes, increase fluid intake
What is pruritis?
Itching and scratching caused by systemic disease e.g. sever liver disease
Describe dehydration as a palliative symptom and management
E.g.headache, cramps dry mouth caused often iatrogenically by meds etc. May also be caused by mouth breathing. Rehydration may cause more problems, small frequent sips of water, mouth care., lip balm
Describe 3 benefits of dehydration in the end of life stages
- Decreased urine output = Decreased toileting/need for catheter
- Decreased respiratory secretions = decreased coughing
- Decreased appetite and thirst means body conserves energy used for these tasks
Describe spiritual distress/depression as a palliative symptom and management
Requires support and understanding, difficult to assess. Aromatherapy, take time to listen, arrange social work if neccessary
Define grief
Personal response to loss
Define bereavement
The period after a loss
Define mourning
The outward and active expression of grief
What factors influence a persons level of grief?
Personality
Culture and religion
Nature of relationship with the person
Way the person died
What is the role of health professionals in end of life care
To educate grieving families about the bereavement process and help them to accept that it will get better
Identify 3 nursing roles in palliative care
Specialist pallaitive care nurse
Palliative care nurse consultant
Nurse practitoner palliative care
Identify 3 nursing management skills in the care of family
- Be present and accepting, LISTEN to them
- Support the right to grieve
- Provide reassurance of normality, don’t offer false reassurance
Identify 5 nursing management skills of palliative symptoms
Reassurance +++
Cool air (Fan or open window)
Elevated position of comfort
Opioids
Comprehensive assessment
