3.7. END OF LIFE CARE/PALLIATIVE CARE

Related Names

None.

Purpose of assistance

When helping a patient who is living out his age:

a) provide pain relief and minimize the impact of other symptoms and discomfort;
b) assure that death is a natural process;
c) integrate the psychological and spiritual aspects of care;
d) offer a support system to help the patient’s family cope with his illness and imminent loss.

Patient description

Inclusion criteria

Patients who are in hospices or receiving palliative care, or patients who receive specific care due to the presence of complaints related to the disease, which is the root cause of the specifics of the care received.

Exclusion criteria

Complaints that are not related to the disease through which the patient receives specific care.

Patient Management

Condition assessment, treatment, intervention

1. Perform a general examination of the patient.

2. If the patient is able to express themselves and make decisions about treatment and transportation, consult with them before providing assistance and/or transportation.

3. If the patient lacks the ability to make treatment and transportation decisions, find any specific directives to provide specific care or information regarding these directives and consent to treatment:

a) Special relief directives;
b) medical order on the maintenance of resuscitation measures (MRPRZ )/RLPRZ (doctor’s order on resuscitation measures) or other forms;
c) guardian, district court or other forms of providing permission to receive assistance that are acceptable in the EMF system.

4. If the patient needs pain relief – see. instruction “Pain control.”

5. If the patient has severe respiratory distress, you can apply:

a) midazolam 2-5 mg IV
OR
b) fentanyl 25 μg mixed with 2 ml of physiological saline or other analgesics.

6. In the presence of vomiting in the patient – see instruction “Nausea/Vomiting.”

7. If the patient has excessive secretions, sanitize.

8. If the patient is experiencing fear, you can apply:

a) benzodiazepines
OR
b) haloperidol 5 mg IV
OR
c) ziprasidone 20 mg IV.

9. If there are signs of dehydration:

a) if the patient can swallow – encourage oral fluids;
b) if available, use special lollipops or swabs wetted in ice water;
c) it is possible to introduce saline IV in a dose of 10-20 ml/kg.

10. If there is no need for transportation, coordinate the action plan with the guardian, district court or other responsible person.

Patient safety

1. A thorough and detailed examination is necessary to identify complaints unrelated to the disease through which the patient receives specific hospice or palliative care.
2. Help should be given with the utmost patience and compassion.

Useful information for training

Key points

1. Social interaction with family members can affect palliative care.
2. The safety of the scene is an important component in the planning of assistance.

Relevant evaluation results

1. Vital signs.
2. The level of pain.
3. Neurological examination.
4. Respiratory noises.

Key elements of documentation

1. Interaction with hospice workers or palliative care providers.
2. Confirmation of the presence of a special medical directive or other special documents.
3. Assessment of pain.

Criteria for the effectiveness of care

1. If there is pain – an assessment of the dynamics of pain.
2. If nausea is present – assessment of relief of symptoms.
3. If dehydration is present – assessment of symptom relief or change in vital signs.