Early ID
care that aims to relieve suffering and improve quality of life for any person living with or at risk of developing a life limiting illness.
What is a palliative care
An assessment (easily missed) when resident is having difficulty swallowing
Conversations that help the resident or Substitute Decision-Maker (SDM) prepare for future healthcare decisions.
What is Advanced Care Planning
The hand that orders the opioid, should also order the ______.
What is laxative
Client is very weak, sits in a chair a couple of hours each day. The rest of the time (more than 50% of the day) he is in bed. He has advance disease and requires almost complete assistance with self care and feeding. He is experiencing ↓ food intake and has adequate fluid intake. He is drowsy but not confused.
What is 40%
Do you think Resident could die in the next 12 months?
What is the surprise question
Discussion with staff after the death of a resident about what went well and what could have gone better.
What is a debrief
The following steps are from_________ guide
1. Set-up
2. Assess
3. Share
4. Explore
5. Close
What is the Serious Illness Conversation Guide
When prescribed an opioid this is the only symptom that will not disappear
What is Constipation
A patient who spends the majority of the day sitting or lying down due to fatigue from advanced disease and requires considerable assistance to walk even for short distances but who is otherwise fully conscious level with good intake
What is a 50% PPS
When residents condition decreases, then _______ should increase
What is care services
Suffering (pain) that encompasses all of a person's physical, psychological, social, spiritual, and practical struggles. Does not respond well to medication.
What is Total pain
The step in the Serious illness Conversation Guide that you use the "Wish, Worry, Hope, Worry" statement.
What is step 3 Share prognosis
Opioids not only help with pain but they also help with
What is SOB or breathing difficulties
A patient who is Quadriplegic requires total care but is placed in a wheelchair daily. He has normal intake and full conscious level.
What is 30% PPS
A proactive identification guide (framework)
What is The Gold Standard Framework
Type of medication given for pain and dyspnea (difficulty breathing)
What is Opioids ei (morphine, Hydromorphone)
External team member that can be called on to help with the palliative approach (pain and symptoms, assessment tools, team debriefs, policies and procedures, family serious illness conversations, and education (formal/informal)
Palliative Pain and Symptom Management Consultant
The ____ scale can be used each shift to assess the residents LOC when starting or increasing an opioid. However, in the first ____ to ____ days there might be increased drowsiness or other symptoms.
What is the POSS scale and the first 3-5 days
Client is up and about on her own. Can do household chores with adequate rest periods. She requires occasional assistance with self care and the caregiver watches her get in and out of the shower. Her intake is reduced but adequate. She is fully conscious with no confusion.
what is 70%
The _______ to care is best delivered by a multidisciplinary/interdisciplinary team and identifies and addresses issues in various domains of a person’s life.
What is The Palliative approach
General changes of decline are a tell tale (months, weeks, days)
Significant intake decline
Significant functionality decline
Multiple hospital visits and not returning to previous baseline
BASE on goals of care not trying to predict EOL stages.
Weight loss > 10% in 6 months
What are general indicators of decline
After its identified that resident is at EOL, family becomes anxious and begin questioning staff about treatment, positioning etc....
What is signs of grieving
Decreased RR 30-40 minutes after administration
´RR 8 or less breaths/min
Myoclonus (jerking)
´Pinpoint pupils
Decrease consciousness w difficulty arousing.
Are all signs of ________
What is overdose
Ms. Jones is a 75 year old woman who has had increasing forgetfulness over the last 3 years. She does self-care with her husband observing her. Sometimes he has to help her. She no longer drives but can walk to the grocery store 3 blocks away in a straight line by herself. She requires a list, however, of what she is to purchase and carries a label with her name, address and her husband’s name to give to someone if she gets lost which has not happened so far. She generally is up during the day and sleeps most of the night. She used to read and knit at night but no longer does so, and will watch television, although she does not always remember what the content is. Meal preparation is done by her husband preparing the ingredients and her cooking the meal. She generally will eat a full meal but recently requires coaxing on occasion
What is 60% PPS