Power point presentation on End of life care

1. END OF LIFE CARE…
Vanitha.Sudalaimani

2. End of life care-Hospice care
◦ "Life is pleasant. Death is peaceful. It's the
transition that's troublesome."
◦ This occurs because the patient, family, or
clinician wait for the other person to begin the
conversation. Thus, confusion, anger, and stress
occur during this most difficult time.
◦ Hospice Care: The model for quality
compassionate care for people facing a life-
limiting illness; providing medical care, pain
management, and emotional and spiritual support
expressly tailored to the patient’s needs and
wishes and support for the family (NHPCO, 2016).

3. What is palliative care…
Palliative care can begin early during
treatment for management of pain, difficulty
breathing, swallowing, and in conjunction
with other disease treatment. This care can
be delivered in any setting including
hospitals, skilled nursing facilities, and the
patient’s home.

5. Non medical care support
◦ Family and loved ones
◦ Spiritual care in end of life care

6. Nursing diagnosis
◦ Compromised family coping
◦ Activity intolerance
◦ Anticipatory grieving
◦ Pain

7. End-of-Life Symptom Management
Common End-of-Life Symptoms
• Powerlessness –to control what happened to them.
• Anorexia and Cachexia -Eat at the dining table (if possible) with family • Plan frequent small meals
that are calorically dense • Prepare meals that require little preparation • Rest before meals
• Fatigue –Multifactorial
Schedule activities at times of greatest energy • Maintain a regular activity schedule • Get assistance from
volunteers, family, and friends • Engage in moderate exercise if able to tolerate it • Participate in yoga
classes • Initiate routine sleep hygiene measures • Manage stress
• Pruritus -Whenever possible treat the underlying condition • Utilization of medications with
antihistamines • Moisturizes added to the bath or placed on the skin • Reduce the amount of bathing, use
tepid water, and mild, unscented soap • Wear loose, no-irritating clothes • Maintain a cool, humidified
room • Avoid scented perfumes and lotions

8. • Alterations in oral mucosaI-
xerostomia : • Encourage frequent meals • oral hygiene • Drink plenty of water or suck on ice chips •
Use artificial saliva (lubricating, hydrating, antimicrobial) • Stimulate salivation with moistening agents or
sialagogues (pilocarpine) • Chew sugarless gum hard candies and mints.
stomatitis: • Analgesics • Use of mouth rinses-e.g., aluminum hydroxide, diphenhydramine, viscous
lidocaine) Saline rinses o 2% viscous lidocaine • mouth care • Avoid spicy foods.
• Nausea and vomiting: • Maintain a cool, odor-free environment. A fan may help to facilitate •
Modify the patient’s diet – bland, not spicy. • Offer small, simple meals. Carbohydrates • Cool, carbonated
drinks • Treat constipation if present – common at end of life • Correct electrolyte imbalance if known .
Assess for symptoms of electrolyte imbalance • Consider switching opioids if transient nausea does not
subside – switch from morphine to hydromorphone or oxycodone • Provide an open view, without clutter. •
Ensure the patient has access to a large bucket or bowl, tissues and water.

9. • Upper Airway Congestion
Pharmacological-Inhaled beta 2 antagonist, Inhaled Steriods, anticholingeric agents.
Non-Pharmacological- High Fowlers/ Tripod position.Oxygen therapy. Direct airflow from fan-Decrease
sensation of breathelessness. Use of relaxation technique.
• Pain

10. WHO developed a three-step ladder for
cancer pain relief in adults.

11. Ascities
◦ paracentesis.
◦ If a patient requires continuous draining of
the fluid, a drainage catheter can be placed
to allow for continuous or intermittent
drainage
◦ Diuretics

12. ◦ Constipation-The significant parameters to assess include: • Degree of distention • Bowel
sounds • Color, volume, odor of vomitus • Level of consciousness • History and onset of
concomitant symptoms
◦ Agitation and Delirium
• Agitation – excessive restlessness, increased mental and physical activity, inability to be
consoled.
• Delirium – an acute alteration in mental status which includes: • Clouding of state of
consciousness. • Development of symptoms over hours to days. • Fluctuation of signs and
symptoms. • Normalization or improvement after treatment of underlying condition, or
spontaneous recovery

13. Self Actualization Needs
Growth illness, peace &
transcendence
Esteem Needs
Value, Respect & appreciation
the persson
Love & belonging Needs
Affection,love and acceptance in the devasting
illness.
Safety Needs
Fears for physical safety,
Dying or Abandonment
Physiological needs
Distressing symptoms-pain &dyspnea

14. Work of Dying…
•Resolving Life issues..
Have I done everything I was supposed to do? How do I fix those things that need fixing or finishing?
• Practical & Emotional Planning for the Well-Being. •What should I do with the house?
• Family members and caregivers may not be ready for this planning as early as the patient. Palliative care
professionals can help by listening to the planning process and act to bridge those conversations.
• Finding meaning in life, suffering, and dying
• Coping with Fears of Loneliness and/or Abandonment. Family members also experience feelings of
loneliness and abandonment as they contemplate the death of their loved one.Patient and family become
the unit of care as they walk through the process together
•Model of death and dying, Elizabeth Kubler-Ross identified "acceptance" as the final stage in the process.
However, at the end of her own life - it can be a very erratic process.

16. Work of dying spiritual issues:
◦ Never think that those who lack a formal religious background or faith practice have no spiritual
issues that they’re working through.
◦ Examining beliefs relating to death, eternal life, and afterlife o People of faith may struggle with,
"I’ve believed this all my life, is it true? Am I being strong enough?" Many people of faith
struggle with a fear of dying because they feel that they should be stronger than that and they
are hard on themselves.
◦ • Reconciling with God or others o Atheists too, who may not believe in an afterlife or Supreme
Being, still struggle with existential issues, “Why was I here? What did I live for? Do I need to be
reconciled with other people?”
◦ • Determining the meaning of pain, suffering, dying process

17. Dying care-Weeks Before Death:
◦ Comfort Measures
◦ Manage dysphagia
◦ A small dropper or oral syringe may be useful to administer liquids, just to moisten the oral cavity
◦ Manage incontinence
◦ Use of incontinence products instead of an indwelling catheter
◦ Protect skin from breakdown if possible
◦ Manage changes in sleep patterns o Maintain a calm environment
◦ Now is not the time to worry about addiction issues o Support the Family
◦ Help them cope with the patient’s emotional withdrawal o Help them cope with feelings of guilt if
present

18. Comfort Measures in the Last Hours
◦ Care of the patient become relatively simple. Sometimes the care of the family
becomes a little more intense in the last day or hours of death as they understand the
significance of what they are seeing.
◦ Let the family know what to expect, both good and bad; remove the fear of the
unknown.
◦ Labored respirations are common and often the most distressing for family members
o Airway congestion leads to noisier respirations. Medication does not always alleviate
these symptoms
◦ Repositioning may help.

19. Nurse should ensure-Dying care
◦ Treat people compassionately
◦ listen to people
◦ communicate clearly and sensitively
◦ identify and meet the communication needs of each individual
◦ acknowledge pain and distress and take action
◦ recognise when someone may be entering the last few days and hours of life
◦ involve people in decisions about their care and respect their wishes
◦ keep the person who is reaching the end of their life and those important to them up to date with any
changes in condition
◦ document a summary of conversations and decisions
◦ seek further advice if needed
◦ look after yourself and your colleagues and seek support if you need it

20. Signs of approaching death Advice
Sleeps more and difficult to wake at times Plan conversation times for when the person seems more alert.
Loses appetite and may ‘forget’ to swallow Offer small servings of favourite foods or drink without forcing. At this
time the body has minimal needs.
Becomes confused about time or may not recognise familiar faces Speak calmly. Remind the person of the day, time and who is in the
room.
Becomes restless, pulls at bedclothes, has visions of people or things
aren’t really there. They may develop a fixed stare
Leave a soft light on in the room and ensure a calm and consistent
environment. Provide reassurance and avoid physical restrictions where
possible. Even if the person cannot respond, don’t assume they can’t
you – hearing is the last sense to be lost.
Loses control of bowels or bladder This does not usually occur until death is close. The amount of urine will
decrease or stop as death nears. The district nurse can advise on how
can be managed.
Secretions collect at the back of the throat and sound like a rattle This is because the person cannot swallow saliva but does not mean
are uncomfortable.Turn the person on their side or raise the head of the
bed. Sometimes medication can be given to help – ask the district nurse
or your community nurse.
Arms and legs cool as the circulation slows down. Sometimes one side
the body will be warm and the other cold. Face becomes pale and feet
and legs adopt a purple-blue appearance. Breathing becomes irregular
and even stops for short periods. The pulse becomes fast and irregular
Use just enough coverings to keep the person comforta