1. What is Palliative Care? n Support and comfort for individuals and families living with chronic or life- threatening illnesses n Focuses on: –Relieving pain and other uncomfortable symptoms –Helping families and friends involved in care giving –Planning for chronic care and facing the end of life

2. Radiation Therapy n Radiation therapy is the medical use of ionizing radiation as part of cancer treatment to control malignant cells n Can be used for curative or adjuvant cancer treatment n Also used as palliative treatment such as pain management n Radiation therapy is commonly applied to the tumor, lymph nodes, or surrounding tissue

3. Chemotherapy n Chemotherapy is the use of chemical substances to treat disease – it refers primarily to cytotoxic drugs used to treat cancer

4. Complementary Therapies n Provide a positive and complementary role or enhancement of the various therapies when used in conjunction with traditional approaches n Examples: –Dietary –Massage –Therapeutic touch –Relaxation

5. Key elements of palliative nursing n Pain management n Symptom management n Cultural considerations n Spiritual care n Communication n Grief, loss, and bereavement n Preparation and care at the time of death n Achieving quality of life at end of life

6. Pain Management n Nursing Assessment – PQRST –P = Pain (what helps, what makes it worse) –Q = Quality (mild, moderate, severe) –R = Region (location of the pain) –S = Scale (1 – 10) –T = Timing (how long does it last)

7. Pain Management n Mild to moderate pain: –Acetaminophen; codeine n Severe pain: –Morphine, hydromorphone, oxycodone, transdermal fentanyl, methadone n Adjuvant analgesics: –NSAIDs, tricyclic antidepressants, anticonvulsants, steroids, oral local anesthetics n Alternate Routes: –Oral, SC, rectal, transdermal, IV

8. Symptom Management for Nausea & Vomiting n Causes: –Constipation/bowel obstruction –Chemotherapy –Radiation –Other meds n Treatment: –Antiemetic (haloperidol, stemetil) –Odour control

9. Symptom Management for Constipation n Causes: –Opiods- Dehydration –Chemo- Inactivity –Radioation n Treatment: –Laxatives used whenever opiods prescribed – stimulant such as Senekot plus a softener such as docusate or colace –Diet: fluids and fruit (prunes, figs, dates) –Mobility

10. Symptom Management of Anorexia/Cachexia n Loss of appetite, poor food intake, weight loss: n Causes: –Medication (can cause nausea, bad taste in mouth) –Pain –Loss of appetite n Treatment: –Improve nausea and appetite –Dietician to be involved to advise and optimize nutritional intake

11. Symptom Management of Dyspnea n Causes: –Pneumonia- anemia –Pulmonary embolus –COPD, CHF – positioning n Treatment: –Oxygen –Opiods –Bronchodilators –Repositioning

12. Cultural Considerations n Culture – the learned, shared, and lifeway practices of a particular group that guides thinking, decisions, and actions in patterned ways n Focus on meeting the needs of each individual person and family, knowing they will experience their culture in their own unique way n Cultural Assessment –Ascertain from the patient –Perceptions (health, illness, death) –Use of or belief in traditional remedies –Roles of family

13. Spiritual Care n Palliative care aims to meet the psychological, social, spiritual, and practical needs of the individual and family n Spirituality has many facets – get to know the preferences related to rituals, symbols, practices, gestures, and meditation – make an attempt to meet these needs

14. Communication n What makes it difficult to talk about death and dying? –Factors making it difficult: Fear of own mortality Denial Language barriers Lack of experience Conflict within the family

15. –Factors making is easier Being honest, genuine, being ‘yourself’ Acceptance of the reality Notion of ‘living until one dies’ Willingness to listen

16. Grief, Loss, and Bereavement n Grief – psychological, behavioural, social, and physical reactions to the loss of someone or something n Mourning – the process by which people adapt to loss n Bereavement – the period after a loss during which grief is experienced

17. Preparation & Care at the Time of Death n Final hours of caring –Keep the dying person comfortable –Not dying alone n Signs of dying process –Decreased LOC –Changes in body function

18. Nursing Care at End of Life n All persons living with and dying from advanced illness need to have access to nurses who provide knowledgeable and compassionate care to lessen the burden of suffering and improve the quality of living and dying