Palliation

What does the family serve as in regards to the plan of care?

a member of the team

What is paradigm shift?

a typical example or pattern of something

What is comfort care?

an approach to the care of the dying that emphasizes the relief of discomfort rather than the cure of illness or prolongation of life

What is hospice care?

benefit available to patients when they receive a prognosis for survival of 6 months or less

What is supportive care?

employs the use of medical interventions to prevent, control, and/or relieve the complications of disease and the associated side effects of specific therapies

What is the trajectory short period of evident decline?

obvious decline in physical functioning, and there are clear prognostic indicators that can help the health care provider identify when the patient is beginning to decline and approaching the dying phase

What is the trajectory prolonged dwindling?

patient typically maintains function for a substantial period of time; then as the disease becomes overwhelming, the patient's status declines rapidly in the final months and days of life

What is symptom management?

requires the use of the best possible evidence to support the specific pharmacologic interventions to manage the multiple symptoms that frequently accompany chronic disease and the dying process

What is palliation?

the active total care of patients whose disease is not responsive to curative treatment

What is end-of-life care?

the care the patient and family receive in the actively dying, terminally ill, or near-death phase of life

What is the function of the ancillary services of the palliative care team based on?

the goals of care, other members of the team can help support the care of the patient and needs of the family

What is the function of the nurse of the palliative care team?

the nurse caring for the patient and the patient's family recognizes the multidimensional needs and aspects that surround advanced disease and death -assesses and evaluates the ongoing needs of the patient's physical, emotional, and spiritual well-being -advocates and provides referrals to the other disciplines of the team.

What is plan of care first based on?

the patient and family's realistic expectations and goals

What is plan of are secondly based on?

the team's assessment, recommendations and support

What is the goal of palliative care?

to achieve the best quality of life for patients and their families

What is the function of the spiritual care of the palliative care team?

-provide spiritual counseling and support for the patient and his/her family -approach should be consistent with the patient's and family's beliefs and desires

What are the types of disease trajectory?

-short period of evident decline -prolonged dwindling -long-term limitations with intermittent episodes

What three different perspectives can the trajectory of disease be viewed from?

-short period of evident decline -sudden death from complications or acute exacerbation -long-term limitations

What are the concepts categories of palliative care?

-symptom management -supportive care -comfort care -end-of-life care -hospice care

What is the goal of the DHHS in regards to the paradigm shift?

-to maintain optimal health and a quality of life for those with multiple chronic conditions -to introduce palliative care earlier into the management of chronic diseases

Who is included as part of the roles of the ancillary services of the palliative care team?

-volunteers -nursing assistants -physical and occupational therapists -art and music therapists -pharmacists -psychologists -psychiatrists

What is the aim of the US Department of Health and Human Services?

-produce a paradigm shift and implement new strategies

What is the impact of chronic disease in relation to palliative care?

-7/10 Americans can expect to live with their diseases several years before dying -major growth has occurred in the number of individuals with diabetes, cardiovascular disease and obesity -majority of health care dollars is spent during the last 6 months of life -increased nursing workforce is needed to keep up with these demands

In which manner will a patient fall under end-of-life care?

-Admission into hospice care -Do not resuscitate order -Expectation that death will occur within 6 months of admission into hospice care -Patient no longer seeks aggressive disease management -Symptom management

In which manner will a patient fall under palliative care?

-Aggressive symptom management such as dyspnea, fatigue, anxiety, depression -Prevention of disease exacerbations -Promote activity, increasing physical functioning -Rehabilitation

In which manner will a patient fall under supportive care?

-Aggressive use of laboratory analysis -Blood transfusions -Bone marrow stimulating factors -Referral to specialty physicians to manage pulmonary disease and symptoms -Used in lung cancer patients undergoing oncology care

In which manner will a patient fall under comfort care?

-Interventions for symptom management -Provide patient and family reassurance -Reduction in physical functioning

What is paramount in palliation?

-control of pain or other symptoms -control of psychological, social and spiritual problems

What diseases are common in the trajectory prolonged dwindling type?

-dementia or Alzheimer's disease -disabling stroke and frailty

What is the function of the physician of the palliative care team?

-directs the medical management of the patient -provide patient evaluation and assessment of clinical manifestations, diagnostics, and interventions.

What concepts are interrelated to palliation?

-evidence -ethics -safety -culture -family dynamics

What does the palliation approach encompass?

-focus on the care of the patient, not the cure of the disease -supportive care, including symptom management -interprofessional approach -patient and family-centered care -collaborative communication -quality of life versus length of life

What is the trajectory long-term limitations with intermittent episodes?

-live for several years with their chronic disease and may have minor functional limitations in activities of daily living -have acute exacerbations that they recover from but eventually are succumb by an acute exacerbation or episode

The palliative care team is composed of what disciplines?

-nursing -social services -physician -spiritual care -ancillary services

What is the function of social services of the palliative care team?

-often bridge the gap between physical and psychologic care for the patient and family -helping to identify areas of need such as communication and isolation issues -assisting in reducing the emergence of crises surrounding unfinished business -connect the patient and family to resources, helping them prepare not only for the death event but also for the grief and bereavement process.

How do you achieve the best quality of life for patients and their families receiving palliative care?

-prevent or treat the symptoms of the disease, or treat the disease as early as possible -prevent or treat the psychological, social and spiritual problems related to the disease or treatment -help patients with chronic conditions live more comfortably