Palliative Care in Patients at a Stage of End of Life

Added on - 18 Sep 2019

  • Dissertation

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PALLIATIVE CARE IN PATIENTS AT A STAGE OF ‘END OF LIFE’1.0.IntroductionFor people living with advanced, chronic ailment, neither counteractive action norcure is conventionally conceivable. Instead of a straightforward goal like survival,which makes as well as a need for the greater part of life, individuals who are livingwith deadly disease have complicated the treatment priorities. In this period of life,care must serve numerous and complex objectives and is influenced by patient, caregiver and medicinal services framework components. Regardless of causes andvariables, the expression "dying" is an ordinary piece of life, passing is frequentlyregarded as a disease. Thusly, many individuals pass on in clinics, alone and in pain(Patrick et al., 2003). Palliative care concentrates principally on reckoning,anticipating, diagnosing, and treating indications experienced by patients with agenuine or life-undermining disease and helping patients and their families settle ontherapeutically vital choices. A definitive objective of palliative care is to enhancepersonal satisfaction for both the patient and the family, paying little heed to finding.Albeit palliative care, dissimilar to hospice mind, does not rely on upon visualization,as the end of life methodologies, the part of palliative care escalates and aggressivesymptom management and psychosocial support (Yoong et al., 2013). Helpingpatients and their families comprehend the way of ailment and anticipation is asignificant part of palliative care close to the end of life. Moreover, palliative careexperts help patients and their families to decide suitable therapeutic care and toadjust the patient's care objectives with those of the medicinal services group (Romeet al., 2011). At last, building up the requirement for a restorative intermediary,propel mandates, and revival status is a basic piece of palliative care toward the endof life. Medicinal services experts including doctor, attendant, diagnologist andparamedical workforce require an in depth understanding on patient problems sothat they could pay attention towards care of patients. The care should be specificespecially in critical situations to save life of patients. Most healthcare professionalsat junior level and student level are lacking the aspects of palliative care. Hence, thetopic of palliative care was selected to describe the essential features from nursingperceptive. The present paper describes the aspects of palliative care for patients inemergency department.1
2.0. Search strategyThe available and popular sources were used to search for the evidences. Thesources, diverse online electronic resources including BNI (British Nursing Index),CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (theExcerpta Medica database), Pubmed, The DARE (Database of Abstracts of Reviewsof Effects), HTA (Health Technology Assessment Database) and NHS (EconomicEvaluation Database). In addition, the available textbooks, magazines and articlesfrom newspapers from library have been searched to find out the relevant literaturefor end of life. The search was made for past 30 years to collect the relevant sourcesand link the evidences to the current context. Adequate measures were made tochannel the quest for the pertinent sources. The keywords utilized for palliative care,end of life, nursing care, patient behaviour etc. The outcome of the search for therelevant sources has been depicted in subsequent sections.3.0.Methodological aspects for palliative care3.1. Evidence based patient assessmentThe first imperative is to discover why the patient is in the emergency departmentand to perform a fast appraisal of their palliative care needs. The physician fromemergency department can start objective directed appraisals and arrangementsthat can keep away from undesirable medicines, unseemly asset use, and undueenduring. An adequate co-ordination among the medicinal services experts isexpected to impart the visualization unmistakably from the "best" observation(Rosenberg et al., 2013). The specialists need to give and portray the clinicalappraisal for any wrong solution and it is to be imparted to next level of wellbeingwork constrain. Sometimes it is not possible to discuss the poor prognosis of diseaseat end stage of life to their families. Instead, the heath care experts can use wordswisely for instance, avoidance of negative statements that may make the patient feelabandoned. The doctors cannot use the statements like “Do you want us to stopaggressive care?” instead, can use the statement like “We are here to ensure thatyou receive the treatment that is best for you and in line with your personal goals.”Based on the need of patient concerning ailment seriousness, the specialist shouldbe offer a key arrangement of treatment that is in accordance with the patient'sdesires. The nurse in charge for the care of patient should summarize the patient’sgoals as per their understand and in accordance with the doctor’s instructions to2
initiate the nursing plan. The nurse should also provide an encouragement to thepatient/surrogate to advocate for their wishes in terms of change of treatment plan ifthe current one is not showing any prognosis.3.2. Need based care3.2.1. DyspnoeaPatients at end stage of life, whose symptoms are going to be changed duringtreatment due to dysfunction of physiological system. Therefore, the patients shouldbe monitored on regular basis for the measurement of vital signs and assessment ofprognosis. Therefore, symptom management in the emergency department is animportant part of nursing service. The patients at a stage of ‘end of life’ are generallysuffer from breathlessness. The discomfort in breathing is a subjective sensationrather than a diagnosis and is very common among many patients with chronicillness, including those with cancer, chronic obstructive pulmonary disease,HIV/AIDS, congestive heart failure, stroke, amyotrophic lateral sclerosis (ALS), anddementia (Policzer & Sobel, 2008). Occasionally, dyspnoea arise from anxiety. Apulse oximeter reading alone is not an indicator of dyspnea; rather, carefulexamination of the patient and appreciation of their distress via facial expression,level of anxiety, ability to speak in full sentences and accessory muscle use canassist in determining the level of discomfort. A normal oxygen saturation and lack ofaccessory muscle use should not preclude treatment of the patient’s describedcomplaint. In such situation, the patient needs to be administered with appropriatemedication and supplementation of oxygen if required.3.2.2. Pain managementMost patients admitted in emergency department with pain due to surgicalprocedures in general and at the stage of end of life in particular may suffer frompain. The pain medication regimen should be revisited in case of poor prognosis andadjusted if required. Facility with titrating common narcotics will allow for adequatecontrol of this prevalent symptom. The repercussions of narcotic analgesics on bodyphysiology should be monitored as narcotic analgesics produce respiratorydepression (Stott & Pleuvry, 1991). A balance for the minimization of adverse eventsand pain suppression is needed for the patients. A combination of narcotic and non-narcotic analgesics is needed for better suppression of pain.3
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