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Symptom Management (Individual Plan (Indiviudal care plans to listen and…
Symptom Management
Individual Plan
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Specialist palliatve care is required: Multi-disciplinary palliative care teams constituted by condition specialists, palliative specialists and care specialists. This way can ensure no needs go unmet
When individual is identified to be dying, an individualised care plan should be conducted to ascertain needs, wishes, symptom management and psychological support. Efficient and timely commuication and involvement in decision-making ensures that patients and relatives can communicate their wishes and be involved in the design of the palliative and end of life care.
FORWARD PLANNING OF CARE AND DESIGNING PALLIATIVE CARE MAY NOT BE NECESSARY: THEREFORE PALLIATIVE CARE SHOULD BE OFFERED TO STROKE PATIENTS FROM THE OFF RATHER THAN AS A CARE SERVICE WHEN HEALTH IS DECLINING
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Recognise everyone is different; no one single approach to palliative and terminal care can be provided
COULD HAVE A BASIC LIST OF MINIMAL THINGS TO DO/MEET BUT ULTIMATELY PALLIATIVE AND END OF LIFE CARE IS DESIGNED BY AND FOR THE PATIENT AND THEIR RELATIVES AS SUITS THEM, NOT THE OTHER WAY AROUND
Physical
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Stroke has a "dying period" throughout which palliative care is required to support the patient and their relatives. Attention from specialists ensures patients and relatives are receiving appropriate care and of the highest standard, to make sure no needs go unment.
Assessing and managing physical symptoms:….Assess the person's physical needs at key points during the course of the illness…assess and manage the person systematically…enquire about symptoms rather than waiting for the person to report them….determine the impact of each symptom on the person's life....ensure that any prescribed drug treatment is as pragmatic and straightforward as possible...refer to a specialist if their is a problem
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Identifying those nearing death: Stroke…persistent vegitative state or minimal concious state or dense paralysis; medical complications, lack of improvement within 3-months of onset, cognitive impairment/post-stroke dementia
GSF Needs based coding: A-B-C-D-E (diagnosis stables (years), unstable/advanced disease (months), deteriorating (weeks prognosis), final days/terminal care (days), after care
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Family Support
Bereavement support should be offered leading up to, immediately and for sometime after the death of a loved one.
ensure relatives know where to seek help but can also be more practical including provision of therapy, prescription of medication and referral to more specialist services.
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Carers and family members emotionally and psychologically affected by the palliative/end of life process. Need appropriate support measures in place to ensure respite can be provided as well as emotional and psychologcial support and training to help them deal with the situation
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Assessing social needs:…Assess the person's social needs at key points during the course of the illness…Be aware that assessment of need can be difficult because some people and their carers may be reluctant to ask for help…Social care and support needs include: emotional support, help with personal care (such as bathing and dressing), housework and shopping, practical aids (for example wheelchairs), caring for dependent (such as children or elderly relatives), and advice on work and employment issues...Offer the person and their carers informed professional assistance to obtain benefits for which they are eligible
Emotional/Psychological
Identifying the end of life: Medical and emotional symptoms to look for; have to also recognise when a patient has stabilised however, as temrinal care may not be needed as immediately as thought #
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Assessing and managing psychological needs:…assess the person's psychological state at key points during the course of the illness…If the person or their carers have significant levels of psychological distress, offer prompt referral to specialist psychological care services...The appropriate psychological intervention will depend on the person's current and previous psychological problems, the level of support available and their prognosis.
Depression and anxiety are major consequences of stroke AND A MAJOR NEED IS TO PROVIDE SYMPTOM MANAGEMENT OF THESE CONDITIONS TO IMPROVE QUALITY OF LIFE. The two conditions are closely linked and can be part of a single emotional response to stroke; assessment measures should be adapted to determine these conditions and also identify those with the conditions who may be unable to communicate their feelings/emotions
Three models of care (NICE Clinical Guidelines) which address depression in adults with chronic physical health problems. Members of the stroke team can provide physical support and clinical neurologists/clinical psychologists provide psychological care and train other service providers.