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Palliative Care

Transcript: Average daily costs to provide palliative care services could also be offset by inviting local groups, that offer volunteer services to nonprofit organizations. Volunteers could provide help with lawn maintenance, clean common areas, or stock supplies. Having volunteer assistance in the areas mentioned above, would save exponentially on cost because personnel would not have to be hired and paid to do those jobs. Palliative Care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is NOT physician assisted suicide. Many people might confuse palliative care and physician suicide but palliative care is simply taking care of dying patients and making them comfortable. The patients also receive emotional support. What is palliative care? Some patients think that their only option is to only live out the last little bit of their life in the hospital or in their home. This is why physicians should be required to tell thier patients all their options including palliative care. Cost-Benefit: Physicians will take seminars at their hospital and will be trained to talk to their patient about their options. They will talk to all terminally ill patients about palliative care and other options that they have. Problem: By: Kendal Lee Physicians would start being required to tell their patients about palliative care. The physician can build a trusting relationship with them so they will become more comfortable and open to their plan of care. Cost-Benefit: Someone will be hired to teach seminars at the hospital so that physicians can learn how to communicate with their patients better. The sliding-scale payment plan would allow anyone who is interested in receiving palliative care find the necessary financial assistance needed to ensure that care is received and not solely based on their ability to pay. Palliative Care Solution: Problem: Palliative care is not often brought up when people are dying due to their terminal illness. Many patients do not receive this information on palliative care simply because their physician is not comfortable talking to them about it.


Transcript: PALLIATIVE CARE EXPERIENCE By: SANTIAGO RUiZ DESCRIPTION Laura Baum is a palliative care doctor that works to control and reduce the pain of patients with a very bad disease. Besides this, her work is also related with helping patients to control the way the are feeling and prepare them for bad news. SWOT HOPE H O P E PALLIATIVE CARE DOCTOR PALLIATIVE CARE DOCTOR CANCER The most common types of cancer in USA are breast cancer, lung cancer and prostate cancer. These types of cancer are the most dangerous ones and they are so difficult to cure if they are discovered in a later stage of cancer. EFFEECT IN HER PERSONAL LIFE She don't want to combine her personal life with her career because all the things and experiences that she have got can change or affect her family in a bad way. FAMILY FAMILY CAREER WORK STAGES OF CANCER The chances of cure cancer are higher if the cancer is in the stage 1 because the cancer is not so developed yet. The chances of cure cancer are pretty low if the cancer is in the stage 4 because the cancer is more developed. citation: STAGE 1 In stage 1 liver cancer, the single primary tumor (any size) has not grown into any blood vessels. The cancer has not spread to nearby lymph nodes or distant sites. STAGE 2 In stage 2, a single primary tumor (any size) has grown into the blood vessels, or there are several small tumors, all less than 2 inches (5 cm) in diameter. The cancer has not spread to nearby lymph nodes or distant sites STAGE 3 In stages 3,there are several tumors and, at least, one tumor is growing into a branch of the portal vein or the hepatic vein. The liver cancer has not spread to nearby lymph nodes or distant sites. STAGE 4 Stage 4 liver cancer is the most advanced form of the disease. In stage 4, the cancer has spread to nearby lymph nodes and may have grown into nearby blood vessels or organs. Advanced liver cancer does not often metastasize (or travel to distant organs), but when it does, it is most likely to spread to the lungs and bones. WHAT SHE WANTS She wanted to help the world in some way, so this career was the perfect option to her for help those people who need it. That’s what she is doing, trying to help her patients and giving the best that she can to let them know that they are not alone, that there is still hope. ADVICES FROM LAURA *Just try to find a way to improve the world. *Do not lose your hope. *Everything's gonna be alright.

Palliative Care

Transcript: Palliative care aims to promote quality of life while easing the symptoms of serious illness. It is care for patients who find themselves in the space between curative and hospice treatment. The World Health Organization (2012) defines palliative care as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering’. (Ivany, 2013) Education and Communication are Key Palliative care improves patient outcomes and decreases intensive care utilization resulting in better quality of life and lower health care costs (Youngwerth, et. al. 2016) "Palliative care is appropriate at any age and any stage of a serious illness." (Youngwerth, et. al., 2016) References Aldridge, M. D., Hasselaar, J., Garralda, E., van der Eerden, M., Stevenson, D., McKendrick, K., & ... Meier, D. E. (2016). Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliative Medicine, 30(3), 224-239 16p. doi:10.1177/0269216315606645 Ivany, E., & While, A. (2013). Understanding the palliative care needs of heart failure patients. British Journal Of Community Nursing, 18(9), 441-445 5p. Ouimet Perrin, K., & Kazanowski, M. (2015). End-of-Life Care. Overcoming Barriers to Palliative Care Consultation. Critical Care Nurse, 35(5), 44-52 9p. doi:10.4037/ccn2015357 Youngwerth, J., Johnson, D. Palliative care: management of common physical and psychological symptoms. In: Glasheen JJ ed. Hospital medicine secrets. Philadelphia, PA: Elsevier Palliative Care Things to Consider Nursing The Intersection of Curative and Comfort for Quality of Life Patient and family Primary care provider Specialist Pharmacist Nutritionist/Dietician People are now living longer End result of chronic illnesses is now the leading cause of death Acute, intensive care is not always appropriate

Palliative Care

Transcript: Reem Al Matrushi "We have enjoined on man kindness to parents" (8) Al-Ankaboot Palliative Care Death is the natural end to life, not a failure of medicine. Relieving physical, psychological & spiritual suffering Close multidisciplinary teamwork Promote the quality of life reduce unnecessary hospital admission specialized medical care for patients with life threatening illnesses & their families * Appropriate for those likely to die in < 12 months, which deaths are ‘predictable’ & follow a period of chronic illness. * Symptom control must be tailored to the needs of the individual. • Carefully diagnose the cause of the symptom • Explain the symptom to the patient • Discuss treatment options • Set realistic goals • Anticipate likely problems • Review regularly End Of Life Care EOLC Pain Pain & general debility * The cornerstone of palliative care * Acute & Chronic pain * Common symptoms : - Weakness - Fatigue - Drowsiness Reversible causes Causes • Drugs • Emotional problems • Biochemical abnormalities • Anaemia • Infection • Poor nutrition • Prolonged bed rest • Raised intracranial pressure * Treat reversible causes * Life style modification * Pain-relieving drugs * Modification of emotional response * Physiotherapy * Psychological support * Prevention * Review home care arrangements Strategies of Management Management * Persist Vomiting Review Medication Review Assess To decrease Nausea • Avoidance of food smells & unpleasant odours • Relaxation, diversion, anxiety management • Acupressure, acupuncture Non-drug measures Non-drug measures Administer antiemetics regularly rather than prn & choose an appropriate route of administration Choose Anti-emetic Bed Sores Mr. Daly, a terminally ill male in his late 80s, a known diabetic, with above-the-knee amputation of a gangrenous left foot & end-stage renal disease with an order for hemodialysis. Having multiple pressure ulcer. Case Scenario Management How would You Manage ! MCQs 65 years old male, presented with sever muscle pain since 4 days. The pain was mainly in the lower limp. On examination; the patient was stable . On inspection; no signs of inflammation or redness of the muscle . How would you manage this patient ? Thank You For Your Afternoon

Palliative Care

Transcript: Stidor Hospice Meaning of the the illness Loss of dignity Dependency Fear Time Concerns about caregivers Grief and loss "Total pain": suffering comes from symptoms and impairment to physical, psychological, spiritual and social equilibrium Curative txs are foregone During end of life + 12 m for families Prognosis of 6 m or less Specific to End of Life ANOREXIA & CACHEXIA Hormonal manipulation Discontinuing medications Privacy FATIGUE, WEAKNESS, ASTHENIA Causes Treatment of Symptoms Look at previous treatments Palliative Care Metoclpramide, chlropromazine, haloperidol Ondansetron, or other 5HT3, dexamethasone for chemo/radiation related Metoclopramine, erythromycin for gastrolparesis Haloperidol, dexamethasone, octeotide, scopolamine for MBO Haloperidol for kidney failure Metoclopramide for liver Zofran for CHF Fatigue Dyspnea Depression Altertations in body image Prevalence: about 15-60% RF: younger, prior hx, uncontrolled sx, type of illness, existential concerns and spirituality Tx: pharmacotherapy, pscyhotherapy, ECT Coping Methods Palliative Care: Look for reversible causes If in line with goals of care, palliative chemo, radiotherapy or endobronchial brachytherapy Linctus (honey or cough syrup) Centrally acting opioid or benzonatate Bronchodilators, steroids, expectorants may help 50 y/o female who presents with pathological fracture is found to have lung cancer throughout skeleton and liver. Agrees to hospice but doesn't want to be DNR. Intubated y/o male with MG. Has living will stating that he doesn't want intubated for more than 14 days, but has been for 24 days. Is alert enough to answer questions, but has significant ICU delerium. Tried to extubate 2x. Looking into trach and LTC placement vs comfort care. Ambulatory, office and home based programs Early in disease can improve outcomes Prognosis Meds Midazolam Levomepromazine Chlopromazine Phenobarbital Propofol CPR witness WATCH Withdrawing care Communicate what to expect Use patient friendly terms Protocol for withdrawal Abondonment issues NAUSEA & VOMITING psych support & coordination of care 80 y/o female intubated in the field for sustained apnea. Has told friend she never wants life support, but son lives in CA and is DPOA and wants to see her before making any decisions. He takes three days to get there. Recommendations Addressing Sexual Health Interdisciplinary team: chaplains, social workers, psychiatrist, pscyhologists Support for family members Patients want us to ask about spiritual needs Navigation of care plans Services Often not addressed--most patients say it is important and want to discuss it and feel that theirs is lacking We need to be doing a better job of setting these up during well visits. Guidelines suggest when any terminal illness is diagnosed. Important to remind family to look at these guidelines for help in making decisions NOT EUTHANASIA for: pain, dyspnea, agitated delirium convulsions, severe psychological distress establishing goals Relaxation Modify activity level Cool air in face Pulm rehab O2 BiPAP Airway debulking and stents Helium/oxygen Acupuncture Treatments Common, multi-dimensional symptom Treat underlying cause Counsel on coping strategies that conserve energy and good sleep hygiene Steroids, psychostimulants may help Moderate exercise and yoga may help Active Dying Hope Family and social support Spititual beliefs and religious community Denial Economic circumstances Hospital based Services Causes Nausea Constipation Taste alterations Dyspnea Depression Watch the family member’s behavior in the waiting room to determine if he or she is an appropriate candidate (ie, relatively calm without exhibition of aggressive actions or excessive display of emotions) to bear witness to the resuscitation. Ask the physician in charge for permission to invite the family member into the resuscitation room. Tell the family member about the patient’s condition before he or she is taken into the resuscitation room. Caution the family member to be prepared for what he or she will see and hear. Help the family member understand physician and nursing activities. Associated with Poor Quality of Life in last 2 weeks 1. Hospitalizations 2. Being in ICU Treatments CASE #3 Megestrol Gluccorticoids Dronabinol Anabolic steroids Omega-3s DHA Amino acids Mirtazapine Growth hormone Decisional Capacity Anticipate the effects including the risks Reassurance Place bleeding lung in dependent position Urgent sedation may be required ICU Concerns CASE #1 Prevalence: over 50% 2nd most common reason to do palliative sedation Anorexia: loss of appetite or reduced caloric intake Cachexia: weight loss of more than 10% of premorbid weight 5-20% of CHF 60% of COPD 85% of CA 20-75% of CKD Family satisfaction improves with good communication, junior clinician giving info, avoiding contradictory info, complete info Improves psychological outcomes for families Meet before hand Understand the family (emotions, inter-family dynamics) Getting started

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