PALLIATIVE CARE.pptx

THIS POWER POINT EXPLAINS HOW CARE OF THE TERMINALLY ILL PEOPOLE ARE CARED

1. PALLIATIVE CARE BY James NYIRENDA

2. DEFINITION Palliative nursing care is a type of care received in the final stages of life when one is stricken with a terminal illness with a goal of making the patient as comfortable as possible during their last days.

3. DEFINITION OR: Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-limiting illness

4. INTRODUCTION PALLIATIVE CARE is given when a patient no longer responds effectively to treatment and has a life expectancy of six months or less. It does not speed up death or delay it. The goal is to make the patient as comfortable as possible during their last days.

5. Goals of palliative care Palliative care aims to relieve suffering in all stages of disease and is not limited to end of life care. The goals of palliative care include: To improve the quality of life To increase comfort

6. . To promote open communication for effective decision making To promote dignity To provide a support system to the person who is ill and those close to them

7. HIV/CANCER/TERMINAL ILLNESS and Palliative Care In CANCER/HIV/TERMINAL ILLNESS-infected individuals, palliative care focuses on symptom management and end-of-life care throughout all stages of the disease.

8. . Individuals may experience various forms of pain and other discomfort Public Health Medical personel,HCWs should identify and treat the underlying cause when possible, while controlling the pain.

9. HIV/CANCER/TERMINAL ILLNESSES and Palliative Care The care of the terminally ill child is a challenge in Zambia because there are few replicable models of planned terminal care.

10. . A child with end stage HIV/terminal illness disease will have more symptoms and will need to take multiple drugs to control and treat a variety of conditions There is need for terminal care preparation for the children and their families and family involvement in decision making

11. Room. A room should be comfortable, safe and convenient for both the patient and the caregiver. This would assure that the patient can have greater degree of mobility with less risk of. The most important consideration is safety.

12. . The room should preferably have an air-conditioner or a fan. The window should be opened to allow ventilation. Lighting should be pleasant and bright.

13. . Use a bed with safety railing on both sides of the bed to prevent falling. Have a comfortable blanket available in case the room becomes too cold in the middle of the night.

14. Preventing falls In a terminally ill person, even a minor fall can cause serious injury. Many falls are due to visual problems, muscle weakness, joint pain and bone pains.

15. . In additions, some medications such as tranquilizers and sedatives can impair alertness and increases the risk of fall. Abnormally low blood pressure, either due to disease or the use of anti-hypertensive medications, can also lead to falls.

16. . Here are some steps you can take to prevent falls: Clear all unnecessary items out of the pathway. Use chairs and tables that are stable and balanced in case the person leans on them for support.

17. . Make sure the room has good lighting. Place a lamp within reach of the person's bed, if necessary. Have walking aids such as a walking frame within reach.

18. Giving medications Give prescribed medication such as chemotherapy and drugs for pain.

19. Nutrition Ill people, particularly if they are bed ridden, often look forward to meal time. It provides them a chance to socialize and to break the monotony. However, some illnesses may cause them to lose appetite or make it difficult for them to eat or swallow.

20. . It is important to provide a healthy diet in order to maintain the patient health and energy. Make mealtime enjoyable and something to look forward to. If there is no diet restriction from the doctor, give him the food he loves and enjoy. Remember also to provide adequate fluid intake of at least 2 liters per day.

21. Hygiene Hygiene is an important component of care giving. If the patient feels clean and fresh, it will boost his morale. Having a daily bath will also prevent bed sores. If he is bed ridden, bath him in bed. Encourage him to brush his teeth twice a day as good oral hygiene will prevent oral ulcers, dental caries, gingivitis and candidiasis.

22. . Men who shave should be encouraged to continue shaving. This will make him feel clean, refreshed and also boost his morale.

23. Toilet Needs If the patient is bedridden, he will need extra help and attention with his toilet needs. He may feel awkward and embarrassed, more so if you feel embarrassed too. Try to be casual and always remember to respect his privacy when he needs it.

24. Using a Commode A commode is a chair with a bedpan attached to its seat. If he is able to get out of bed, it is better to encourage him to use a commode. This not only allows him a degree of independence but also more privacy.

25. . Bring the commode near the bed. Then assist him to the commode. Make sure he is seated comfortably before leaving him to complete his toilet needs. Do not rush him. Give him plenty of time. When he is done, ask him to call for you so that you can clean him up and assist him to his bed.

26. Using a Bedpan If she is totally confined to bed, then it is necessary to use the bedpan. For a man, a handheld urinal would be adequate for him to pass urine. Note that he may be reluctant to ask for one, so ask him frequently whether he needs one. Always give him complete privacy and plenty of time.

27. Observations Vital signs and observe for vomiting. Observe for pallor Observe for cyanosis Mental status Appetite

28. . Psychological, spiritual guidance and help him to cope with dying Pain and symptom management Teaching family members how to care for their loved one Offer bereavement care and counseling to surviving family members

29. COMMUNICATION: Terminal Illness The nurse: Clarifies what was said Listens to concerns Fosters communication between MD, client, and family

30. . Allows patient to express loss Facilitate grief through nursing process Be available for patient Assist patient to identify needs/hopes for remainder of life Connect patient with proper resources

31. Nursing strategies appropriate for grieving persons Open ended statements Patient sets the pace Accept any grief reaction Be aware—nurse may be target of anger Remove barriers

32. . Avoid giving advice Allow patient to talk Allow patient to express signs of hope Support hope by helping focus

33. COUNSELING & Assist Family to Grieve Explain procedures and equipment Prepare them about the dying process Involve family and arrange for visitors Encourage communication Provide daily updates

34. . Resources Do not deliver bad news when only one family member is present

35. Choices of Care Setting: HOSPICE Families have choices of where to care for the dying loved one Ask the patient and family preferences Support whatever the choice Hospital, Home/Hospice

36. Elements of Hospice Care Home care coordinated with hospital Control of symptoms holistically Physician directed care

37. . Utilization of variety of health care professionals Bereavement follow up care Acceptance based on need, not Money

38. . Nursing strategies to meet physical and psychosocial needs of the dying patient

39. . Thorough pain control Maintain independence Prevent isolation Spiritual comfort Support the family

40. Signs/Symptoms of Approaching Death Motion and sensation is gradually lost Increase in temperature Skin changes-cold, clammy Pulse-irregular, and rapid Respirations-strenuous, irregular, Cheyne stokes “Death rattle”

41. . Decrease Blood Pressure Jaw and Facial muscles relax MOST POSITIVE SIGN OF DEATH=Absence of brain waves, Pupil dilatation(Need two Doctors to sign off)

42. GRIEF,LOSS,DEATH AND DYING Loss is a universal experience tha occurs throughout the lifespan Grief is a forma of sorrow involving feelings, thoughts and behaviours caused by bearevement . Responses to loss are strongly influenced ones cultural background

43. . The grief process involves a sequence of affective,cognitive and psychological states as a person responds to and finally accepts a loss. LOSS- something of value is gone GRIEF-Total responds to emotional experience related to loss. BEREAVEMENT-Subjective response to by loved ones

44. . MOURNING-Behavioral responds to Loss

45. STAGES OF GRIEF STAGE: RESPONDS D Refuses to believe that loss has happen A Retaliation B Feelings of guilty, punishment of sin D Laments of what has happened A Begins to plan

46. WHAT IS DEATH The end of life Full cessation of vital actions Permanent state in the field of biology All living things eventually die

47. ATTITUDE TOWARDS DEATH AND DYING Present generation may be unaware of feelings Prolonging life Common fears

48. The 5 Stages of Grief Denial Anger Bargaining Depression Acceptance

49. Stage 1: Denial Refusing to believe a probable death will occur. You can help others face it by being available for them to talk instead of forcing them to talk about it.

50. Stage 2: Anger Once the diagnosis is accepted as true, anger and hostile feelings like the following can occur: Anger at God for not allowing them to see their kids grow up Anger at the doctors Anger at the family Try not to take it personally. They have a right to be angry so allow them to express themselves so they can move on in the grieving process.

51. Stage 3: Bargaining They dying person may start to negotiate with God i.e. “I’ll live a healthier life,” “I’ll be a nicer person,” “I was angry so let me ask nicely to please let me live.” They may negotiate with the doctor by saying, “How can I get more time so I can live in my dream home, and so on. There is a deep sense of yearning at this stage to be well again.

52. Stage 4: Depression When reality sets in about their near death, bargaining turns into depression. Fear of the unknown Guilt for demanding so much attention and depleting the family income occurs. Be available to listen instead of cheering them up, or rambling, repetitive talk. Distraction like talk about sports, etc., is good but don’t ignore the situation.

53. Stage 5: Acceptance When the dying have enough time and support, they can often move into acceptance. There is an inner peace about the upcoming death. The dying person will want someone caring, and accepting by their side.

54. NOTE:! The stages don’t always occur in order. Whether you are the patient or the loved one, nobody escapes grief. People grieve at different rates of time. Delayed grief can occur when people suppress the emotions of the death and years later, get depressed. Cultural differences, age, gender, race, and personality change the way people grieve. Bereaved persons have higher rates of depression, and are at greater risk for illness than non-bereaved.

55. Nursing care after death Check orders for special requests Remove equipment Remove supplies Change soiled linens and cleanse patient Use room deodorizer

56. . Place patient in supine position, with small pillow under head Insert dentures Remove valuables and give to family Stay with family, if requested

57. After the family leaves Tag patient according to hospital/agency policy Wrap body in shroud Put ID tag on shroud Transfer to Mortually Document

58. Helping Children Cope Be straightforward; distortions can do lasting harm i.e. “he’s gone to sleep” can lead to a fear of sleep or “God took her,” leads to a hate for God. Reassure that they are no way to be blamed and will be taken care of. Let child participate in the family sorrow and grief. Give as much attention to the child who cries as to the one who doesn’t cry. Silence between family and friends makes it worse. Don’t say, “you are the man of the house now” or “be brave.”

59. Grieving Life Events Events like divorce, separation from children, break-up of boyfriend/girlfriend, losing a job/unemployment, can feel like going through an inner death. The stages of denial, anger, bargaining, depression, and acceptance also occur in these circumstances. Feeling “dead” in our job, in our relationship, in our roles, in our bodies is a reality with many people.

60. . Do drugs “deaden” your emotions and energy? Does a mother or father “deaden” your enthusiasm? Turn away from these “deadening factors” and choose to find peace, meaning, value, and purpose in your life.

61. How to Cope with Death Allow yourself to grieve by looking at pictures, playing nostalgic music, and reading old letters. Use dance as a way to express how you felt. Use painting/drawing to express your feeling. Imagine how Jesus , Buddah , Mohammed, or a greak oak tree would tell you how to cope with it. Funerals, ceremonies, and rituals help people with the grieving process.

62. . THANK YOU