WK 11- PALLIATIVE CARE

Question 1

What is palliative care

Answer 1

providing holistic care to a patient who has been diagnosed with a progressive and advanced life limiting disease

Question 2

What are the 4 PRN medications prescribed to dying patients and why

Answer 2

1. Morphine- for pain and SOB
2. Midazolam (benzo)- for agitation and anxiety
3. Anticholingergic- block saliva and mucous production
4. Haloperidol- antiemetic

Question 3

What is deprescribing and why is it done

Answer 3

Deprescribing is done once a patient has deteriorated signficantly/is in palliative- it involves reducing the tablet burden through reducing medications that have toxic side effects, treat long term complications, treat bp/diabetes, or prolong life

Question 4

What are the 6 signs looked for to confirm death

Answer 4

1. No breath sounds for 2 minutes
2. No breathing effort or breath felt
3. No carotid pulse
4. No heart sounds for 2 minutes
5. Fixed dilated pupils
6. No response to noxious stimuli (finger press)

Question 5

What are the 5 principles of palliative care

Answer 5

1. Focus on QOL
2. Whole person approach
3. Care encompasses dying person and the people that matter to them (family, friends)
4. Patient autonomy and choice
5. Open and sensitive communication

Question 6

What is opioid toxicity- symptoms

Answer 6

Occurs when a pt receives above normal dose for opioids-> can be due to charting error, dosing error, changing between opioids, fast metabolisers
Symptoms- resp depression or distress, pinpoint pupils, myoclonic jerks, drowsiness

Question 7

What are the signs that imminent death is approaching

Answer 7

Early= bed bound, no interest in food or water, cognitive changes
Middle= bed bound, further decline in mental capacity
Late= coma, fever, altered breathing patterns, cold extremities/mottled skin, death rattles (due to increased mucous/saliva secretion and difficulty swallowing/clearing airway)

Question 8

What is an EPoA

Answer 8

Enduring power of attorney- someone who will advocate for your health and finances once you are no longer able to make sound decisions

Question 9

What documents are included in the advanced care planning

Answer 9

EPoA, Advanced Health Directive

Question 10

What is an ARP

Answer 10

Acute resuscitation plan- states the patients wishes on whether they would like to be resuscitated and states it in their own words, along with stating whether the pt has an EPoA or Advanced health directive

Question 11

What is an AHD

Answer 11

Advanced health directive- gives the patients scenarios and asks what their wishes are regarding having medicinal care that may shorten life (artificial hydration, antibiotics etc)- is long and clunky and requires 3 people to sign it

Question 12

What is a statement of choices

Answer 12

States what the patient wants and guides treatment- is not a legal document but is used to support advanced care planning

Question 13

What are the legal documents

Answer 13

Advanced health directive, EPoA, Will

Question 14

What medications are continued with palliative care

Answer 14

Morphine- pain and SOB
Frusemide- SOB
B-blocker- help with discomfort of arrhythmia/SOB
Buscopan- anti-cramp/death rattles (anticholinergic)
Nilstat Antifungal- incease QOL through mouth/lip care
Oxygen- in moderation