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End of Life Care

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tomi1's version from 2017-03-08 14:42

Section 1

Question Answer
causes of deathHeart: IHD Neuro:CVA+dementia Resp: COPD Malignancies
largest age group of death >40% death in over 60year olds
what is end of life carehealth care for advance, progressive, incurable illness (terminal: cancer/HF/COPD/PD)
purpose of palliative careimproves QOL in LT illness, treat pain, physical symptoms, social and spiritual needs
is diagnosis of dying permanentNO it can be reversed
advanced care plan definedocumenting future care plan when patient no longer has capacity to communicate own decisions
3 components of advance care planningadvance statement, advance decision to refuse Rx, Lasting power of attorney
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Section 2

Question Answer
5 principles to discharge planning EOLC1.recognise dying 2.communicate family/staff 3.patient's wishes 4.support family/carers 5.plan and manage
plan and management in EOLC1.DNACPR 2.hydration and nutrition 3.anticipatory medications 4.syringe driver 5.stop unncessary medications/investigations 6.CONSIDER SPIRITUAL/SOCIAL NEEDS
3 palliative care principles for EOLCwithdrawal of treatment, withhold treatment, palliative sedation
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Section 3

Question Answer
Bereavement support for familybereavement officer
Explaining dying process to family drowsy, weaker, body shuts down (less need for food)
responsibilities of Dr in funeral processmedical certificate (cause of death)- needed in order to register death
how long does DR have to register a death<5days, + medical certificate
what is the green certificatefor funeral/cremation
what is BD8certificate of registration of death for deceased person's assets
certificates given from registra office green certificate + BD8
Medical responsibility cremationPart 1 cremation form: deceased name,address, occupation
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Section 4

Question Answer
who to inform of DNACPRif patient has capacity must be informed of DNACPR decision
when not to discuss DNACPRif will cause patient physical or psychological harm
is CPR successful MOST WILL DIE REGARDLESS -only 1/8th survive to discharge
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Section 5

Question Answer
4As anticipatory medicationsanalgesia-antiemetics-antisecretory-anxiolytics
Analgesia prescriptiondiamorphine 2.5mg SChr
Analgesia indicationbreakthrough pain
Analgesia CIliver or kidney failure
SE of morphineconstipation/ nausea
What medications must be prescribed with morphineanti-emetics + laxative
Antiemetics prescriptionlevomepromazine 5mg PRN (max 50mg)
Antiemetic CI Dementia (increase mortality or CVA)
Antiemetic SEEPSE or neuroleptic malignant syndrome
anti-secretory prescritptionHyoscine butylbromide 20mg 4hr (240 mg in 24hrs)
anti-secretory CIparalytic ileus
anti-secretory SE constipation + bradycardia+ dry mouth
anxiolytics prescritptionmidazolam 2.5mg 4hr (60mg in 24hrs)or lorazepam 4mg
SE anxiolyticsdry mouth
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