{"id":1374,"date":"2018-04-22T11:12:49","date_gmt":"2018-04-22T05:12:49","guid":{"rendered":"http:\/\/bdpallcare.com\/new\/?p=1374"},"modified":"2018-04-22T11:13:48","modified_gmt":"2018-04-22T05:13:48","slug":"end-of-life-care-last-hours-and-days-of-life","status":"publish","type":"post","link":"http:\/\/bdpallcare.com\/new\/2018\/04\/22\/end-of-life-care-last-hours-and-days-of-life\/","title":{"rendered":"End of life care (Last hours and days of life)"},"content":{"rendered":"

\u00a0\"\"<\/strong><\/p>\n

    \n
  1. Identifying a dying patient (diagnosing dying)\n
      \n
    1. Differentiate between patients with a malignant vs non-malignant diagnosis<\/li>\n<\/ol>\n<\/li>\n
    2. Deciding whether to initiate life-sustaining treatments vs active palliative management.\n
        \n
      1. Withholding inappropriate<\/strong> life-sustaining treatments is easier than\u00a0 withdrawing them<\/li>\n
      2. Local legal requirements (ethical requirements will be covered separately)<\/li>\n<\/ol>\n<\/li>\n
      3. Psychosocial care\n
          \n
        1. Communicating effectively with the family that the patient is dying<\/li>\n
        2. Goals of care<\/li>\n
        3. Preferred place of death (what resources are available if the family wants to take the patient home; ensuring adequate medication supply etc).<\/li>\n
        4. Carer education on what to expect as the patient approaches death, mouth care, administration of medication, bowel and bladder care etc<\/li>\n<\/ol>\n<\/li>\n
        5. Physical care\n
            \n
          1. Discontinue non-essential medications, monitoring, and treatments<\/li>\n
          2. Appropriate drugs and route of administration<\/li>\n
          3. Mouth, bowel, bladder cares<\/li>\n<\/ol>\n<\/li>\n
          4. Spiritual care<\/li>\n
          5. Symptom management at the end of life\n
              \n
            1. (Most symptoms will be covered in separate talks)<\/li>\n
            2. Terminal agitation<\/li>\n
            3. Death rattle<\/li>\n
            4. Anticipatory prescribing<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n

              References:<\/p>\n

                \n
              1. https:\/\/www.caresearch.com.au\/caresearch\/tabid\/746\/Default.aspx<\/a><\/li>\n
              2. Ellershaw J, Ward C. Care of the dying patient: the last hours or days of life. BMJ 2003;326:30-34<\/li>\n
              3. Scarre G. Can there be a good death? Journal of evaluation in clinical practice 2012;18:1082-1086<\/li>\n
              4. Palliative care formulary \u2013 PCF5<\/li>\n
              5. Hugel H et al. Respiratory tract secretions in the dying patient: A comparison between glycoyrronium and hyoscine hydrobromide. Journal of palliative medicine 2006;9(2):279-285<\/li>\n
              6. Irwin S.A Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice. Journal of palliative medicine 2013; 16(4):423-435<\/li>\n
              7. Kapo J. Palliative care for the older adult. Journal of palliative medicine 2007;10(1):185-210<\/li>\n
              8. John L Schuster, Jr. Delirium, confusion, and agitation as the end of life. Journal of palliative medicine 1998;1(2):177-187<\/li>\n
              9. Fast facts: https:\/\/www.mypcnow.org\/fast-facts<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                \u00a0 Identifying a dying patient (diagnosing dying) Differentiate between patients with a malignant vs non-malignant diagnosis Deciding whether to initiate life-sustaining treatments vs active palliative management. Withholding inappropriate life-sustaining treatments is easier than\u00a0 withdrawing them Local legal requirements (ethical requirements will be covered separately) Psychosocial care Communicating effectively with the family that the patient is …<\/p>\n

                End of life care (Last hours and days of life)<\/span> Read More »<\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-1374","post","type-post","status-publish","format-standard","hentry","category-education"],"_links":{"self":[{"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/posts\/1374","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/comments?post=1374"}],"version-history":[{"count":3,"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/posts\/1374\/revisions"}],"predecessor-version":[{"id":3614,"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/posts\/1374\/revisions\/3614"}],"wp:attachment":[{"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/media?parent=1374"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/categories?post=1374"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/bdpallcare.com\/new\/wp-json\/wp\/v2\/tags?post=1374"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}