Palliative care

3. 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.

4. DEFINITION

5. GOALS
• GENERAL GOALS
Prevent and relieve suffering
Improve quality of life

6. • 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.

10. 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

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

13. 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

14. 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

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

16. PAIN MANAGEMENT
• Opioid analgesics – morphine,
hydromorphone, fentanyl, oxycodone

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

19. 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.

20. 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.

21. • 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.

22. HOSPICE CARE

23. • 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.

24. 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

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

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

27. • 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.

28. 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

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

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