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Palliative Care (Emergencies/Common Symptoms (Pain (Opiods (Breakthrough…
Palliative Care
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Terminal Phase
Pre Active ( 2 weeks)
- Restlessness
- ↓ Appetite
- ↑ Fatigue
Active (3 days)
- Hypotension
- ↓ Temperature
- Unresponsiveness ( laspes in consciouseness)
- Swelling
- Apnoea
- Circulation changes (Cyanosis)
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Grief and Bereavement
- Bereavement refers to the event of death of a person with whom there has been an enduring relationship.
- Grief is how bereavement affects us personally, with effects across several domains – emotional, cognitive, social, physical, financial and spiritual.
- Depression, Anxiety, Anger, Lonliness, Shocl/Numbess, loss of pleasure
- Thinking about the person who has died all the time
- Sense that the dead person is still around
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- Susceptibility to illness
Abnormal/Complicated Grief
- yearning and longing for the deceased that impacts negatively on a person’s relationships, employment and life.
- Risk Factors
- Past hx of depression
- Coexisting stressors ( financial hardship)
- Pre-bereavment depression
- Widower or mother
- Experienced multiple losses
- Childhood loss of a parent
- Insecure attachment style, neglect, Childhood abuse
- Identifying people at risk of " Complicated bereavement" is important during the palliative period
- CBT and Antidepressants - shown to be effective
Conditions to be managed
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End Stage CHF/Renal/Liver failure
- medical management of symptoms, but no trying to preserve life
- Comfort measures
- CKD: Consider dialysis
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OSCE PRACTICE SCENARIOS
- You are a Junior Doctor on the night shift called to review a patient on the Pallaitive care ward who has recently become very agitated and claims to be "seeing things". Demonstrate what you would assess ( Hx, Ex, Inv, Notes) and your initial managment?
- You are a junior doctor called to review Mr Jones who is complaining of severe pain despite regular analgesia. He is currently on.....
Please assess MR Jones
What would your management be? What else would you consider in your management?
Healthcare Provider Duties after patient death
- Complete legal requirements:
- Certify the death
- Complete death Certificate
- Cremation documentation
- ?Coroner reporting
- Containing funeral director
- Offering contact to minister of religion or funeral celebrant
- Contacting the community nursing team
- Communicating death to relevant healthcare providers and health services
GOALS
- Provides relief from pain and other distressing symptoms
- Affirms life and regards dying as a normal process.
- Intends neither to hasten nor to postpone death.
- Integrates the psychological and spiritual aspects of patient care.
- Offers a support system to help patients live as actively as possible until death.
- Offers a support system to help the family cope during the patient’s illness and in
their own bereavement.
- Uses a team approach to address the needs of patients and their families, including
bereavement counselling, if indicated.
- Enhances the quality of life, and may also positively influence the course of illness.
- Introduced early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
Certifying Death
- No Carotid Pulse and No Heart Sounds for 2 minutes
- No breath sounds heard for 2 minutes
- Fixed, unresponsive to light adn Dilated pupils
- No response to centralised Stimulus
- No motor response/ facial grimace to pain
