1. what is palliative care?
    holistic approach to care which provides relief from distressing symptoms and allows patients to live as actively as possible until death
  2. what is end of life care?
    pt who are expected to die within the next 12 months
  3. what does palliative care integrate?
    • physical 
    • spiritual 
    • social 
    • cultural psychological aspects
  4. what is the EoLC pathway?
    • step 1- discussions as the end of life approaches 
    • step 2- assessment, care planning and review 
    • step 3- co-ordination of care 
    • step 4- delivery of high quality services in different settings 
    • step 5- care in the last days of life 
    • step 6- care after death
  5. what are common palliative care conditions?
    • chronic neurological conditions 
    • COPD 
    • heart failure 
    • renal failure 
    • elderly/ frail 
    • cancer
  6. explain lung fail
    • increase in fluid build up 
    • reduced cough reflex 
    • build up of fluid causes death rattle 
    • fluid reduced gaseous exchange 
    • hypoxaemia and pneumonia
  7. explain heart failure
    • systemic hypoxia causes cardiac arrhythmias 
    • weak pulse 
    • resulting in- weak, drowsy, poorly perfused, drenched in sweat or clammy
    • pale skin due to falling BP
  8. explain reduced metabolism
    • often off food due to reduced metabolism 
    • can be worsened by meds 
    • blood divert away from GI tract, consipation or possibly diarrhoea 
    • opioids slow down GI tract and could worsen abdominal pain
  9. explain renal failure
    • hypotension leads to renal failure, kidneys under perfused.
    • toxin build up in blood, further stressing the heart 
    • toxin build up may cause inflammation similar to sepsis 
    • this caused by prostaglandin release which can also fever
  10. explain nervous system failure
    • senses are dulled, touch pressure and hearing amoungst last to go 
    • vision dulled, may only be able to see light and dark
    • can be unresponsive with eyes open
    • can be twitching, grimacing or displaying other signs of pain
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