2. Objectives
To know the definition of Palliative Care.
To understand the physiological changes in the
following systems and to provide care.
Circulatory System
Integumentary System
Neurological System
Respiratory System
Urinary System
Gastro-intestinal System
3. Palliative Care
Palliative care is an approach that improves the
quality of life of patients and their families facing
the problem associated with life-threatening illness,
through the prevention and relief of suffering by
means of early identification and impeccable
assessment and treatment of pain and other
problems, physical, psychosocial and spiritual.
http://www.who.int/cancer/palliative/definition/en/
4. Changes in Circulatory System
Decreased Blood Perfusion
• Mottled or discolored skin
Decreased Cerebral Perfusion
• Decreased Level of Consciousness
• Delirium
• Disorientation
• Hallucination
• Drowsiness
Promote good Skin care.
Orientate gently.
Be patient.
6. Changes in Circulatory System – Cont’d
Decreased in Cardiac Output & Intravascular
volume.
• Tachycardia
• Hypotension
• Peripheral cyanosis
• Peripheral cooling
• Pulse become weak and irregular (death is imminent)
Slow down and pace out
activities.
7. Changes in Integumentary system
Increase risk of pressure related injuries.
• Decreased blood perfusion
• Decreased mobility
• Decreased nutritional status
• Increased risk of friction & shearing
Pressure relieving devices
Regular turning
Gentle handling
Good Hygiene
Moisturize
8. Changes in Respiratory System
Cheyne-Stokes Breathing
Dyspnoea
Agonal Gasp
Death Rattle Semi-Fowler’s position
Oxygen Therapy
Gentle Fan blowing
Oral toilet
Assure Family – normal process of dying
9. Changes in Neurological System -
Confused, Disorientation, Hallucination,
Delirium, Drowsiness, Decreased or Loss of
consciousness
• Decreased circulation to the brain
• Decreased oxygen to the brain
• Medication induced
• Decreased attention span
Orientate if needed
Low stimuli environment
Therapeutic touch
Gentle massage
10. Changes in Neurological System – Cont’d
Difficulty understanding or finding the right words
Sensation and power loss in legs first, followed by
hands
Pupils might become sluggish to light
Pain might be significant
Assurance
Analgesics / Pain relieving measures
11. Pain
General pain assessment
Assessment of pain in non-verbal resident
Pharmacological management
Non-drug interventions for pain
Nursing assistant role in observing and relieving
pain
16. Changes in Urinary System
Decreased Urine output
• Decreased intake
• Blood pressure too low for kidney filtration
Possible Incontinence
Keep resident clean and dry.
Ensure Comfort.
17. Changes in Gastro-intestinal system
Decreased appetite
Decreased urge to drink
Difficulty swallowing
Constipation
Bowel incontinence
Comfort feeding
Thickened Fluid
Excellent oral care
Hygiene needs
Perineal Care
18. Other physiological changes
Edema
• Hypoalbuminemia
• Underlying medical conditions
• E.g. Cardiac failure, Liver failure, Renal failure
Hair loss
• If on chemotherapy
Stress importance of QOL of Patients and their Families.
Some of the actions done are not so much for patients, but for families to understand and feel better.
Ask staffs what can a nurse do in such a situation.
Ask for examples when appropriate.
Death rattle : They may not be physically strong enough to cough or swallow to clear the secretions from the back of their throat.
Secretions in the throat or the relaxing of the throat muscles can lead to noisy breathing, sometimes called the death rattle. Repositioning the person, limiting fluid intake, or using drugs to dry secretions can minimize the noise. Such treatment is aimed at the comfort of the family or caregivers because noisy breathing occurs at a time when the dying person is unaware of it. The death rattle does not cause discomfort for the dying person. This breathing can continue for hours and often means that death will occur in hours or days.
Cheyne-Stokes respiration (CSR) is one of several types of unusual breathing with recurrent apneas (dysrhythmias). Reported initially in patients with heart failure or stroke, it was then recognized both in other diseases and as a component of the sleep apnea syndrome. CSR is potentiated and perpetuated by changing states of arousal that occur during sleep. The recurrent hypoxia and surges of sympathetic activity that often occur during the apneas may have serious health consequences. Heart failure and stroke are risk factors for sleep apnea. The recurrent apneas and intermittent hypoxia occurring with sleep apnea further damage the heart and brain. Although all breathing dysrhythmias do not have the same cause, instability in the feedback control involved in the chemical regulation of breathing is the leading cause of CSR. Mathematical models have helped greatly in the understanding of the causes of recurrent apneas.
PMID: 16377843 DOI: 10.1385/NCC:3:3:271
Common cause of agonal gasp is Cerebral Ischemia.
Decreased circulation to brain = Decreased brain function.
Pain is usually brought about by underlying diseases.
Hypoalbuminemia can be caused by various conditions, including nephrotic syndrome, hepatic cirrhosis, heart failure, and malnutrition; however, most cases ofhypoalbuminemia are caused by acute and chronic inflammatory responses. Serum albumin level is an important prognostic indicator
