Palliative care.pptx

Palliative care

1. MEANING Palliative care is any form of care or treatment that focuses on reducing the severity of disease symptoms, rather than trying to delay or reverse the progression of the disease or provide a cure.

2. DEFINITION

3. GOALS GENERAL GOALS Prevent and relieve suffering Improve quality of life

4. SPECIFIC GOALS Provide relief from symptoms including pain Regard dying as a normal process Affirm life and neither hasten nor postpone death Support holistic patient care and enhance quality of life Offer support to patients to live as actively as possible until death Offer support to the family during the patient’s illness and in their own bereavement.

5. PALLIATIVE CARE TEAM Care assistants Generalists & specialists nurses Health workers Pharmacists Chaplains Recreation officers Physician Pain specialist Psychologists/psychiatrist Physical, occupational, music, art, play therapist

6. Factors affecting provision of palliative care Lack of utilities Lack of awareness and improper decision making Economy Lack of health care workers

7. ETHICAL ISSUES Autonomy: right of a person to decide his/her own course of action Nonmaleficence : doing no harm Beneficence: doing good by alleviating suffering Justice : by the way of providing quality of care

8. Role of Nurse in palliative care Direct nursing care Meeting physical needs & symptomatic management Providing psychological reassurance Monitoring & administering pain relief measures Preventing further complications Patient & family education

9. Facilitating participation of significant others in patient care Specialized nursing care – lymphedema management, wound care, stoma care, bowel & bladder care.

10. PAIN MANAGEMENT Opioid analgesics – morphine, hydromorphone, fentanyl, oxycodone

11. Adjuvant analgesic therapy Antidepressants - amitriptyline Antiseizure drugs - carbamazepine NSAIDs – ibuprofen, naproxen Anticholinergics – dicyclomine Benzodiazepines – lorazepam, diazepam

12. Analgesic dosing Dose is determined based on the type & intensity of pain as well as the response to current analgesics. Therapeutic level of analgesics must be maintained at all times for clients with persistent or chronic pain. Therefore an around-the-clock (ATC) schedule is most appropriate. Short acting oral morphine requires dosing every 4 hours; controlled release medications offer schedules of every 8, 12, or 24 hours. Rescue dosing

13. NUTRITIONAL SUPPORT Common nutritional problems are anorexia, malabsorption, cachexia Prokinetic agents such as metoclopramide are used to increase gastric emptying. If adequate nutrition cannot be maintained by oral intake, nutritional support via enteral route may be necessary.

14. If malabsorption is a problem, vitamin supplements may be instituted. For cachexia, creative dietary therapies, enteral feedings or parenteral nutrition may be necessary to ensure adequate nutrition.

15. HOSPICE CARE

16. The root of the word hospice is hospes meaning “host” Hospice is a coordinated program of interdisciplinary services provided by professional caregivers and trained volunteers to patients with serious, progressive illnesses that are not responsive to cure.

17. Principles Underlying Hospice Care Death must be accepted Patient’s total care is best managed by an interdisciplinary team. Pain and other symptoms of terminal illness must be managed. The patient and family should be viewed as a single unit of care. Home care of the dying is necessary

18. Bereavement care must be provided to family members Research and education should be ongoing.

19. Eligibility criteria for hospice care General Serious, progressive illness Limited life expectancy Informed choice of palliative care

20. Hospice – specific Presence of a family member or other caregiver continuously in the home when the patient is no longer able to safely care for him/herself.

21. Levels of hospice care Routine home care – care provided in patient’s home with hospice staff Continuous home care – more intensive care in the home requiring skilled nursing for at least 8 to 24 hours per day. Respite care – patients are transferred to an IP facility to give caregivers a break from the physical & emotional stresses of caring

22. Inpatient care – admission to an inpatient facility when acute problems require medical and nursing management.

23. HOSPICE SERVICES Nursing care Medical social services Physician’s service Counselling services Home health aide Physical/occupational/speech therapy Bereavement follow up Medical supplies for palliation