CARE OF TERMINALLY ILL

CARE OF TERMINALLY ILLCARE OF TERMINALLY ILL

INTRODUCTION

Terminally illness is a state in which an individual faces/medical conditions that will end in death within limited period. KUBBLER ROSSORTerminally ill people are those with active&progressive disease for which curative treatment is not possible/not appropriate &from which death can reasonably be expected within. NATIONAL HOSPICE ASSOCIATIONDEFINITION

*Increasing no of terminally ill*Imroves quality of life*Acess& avaiability of services.Symptom control & pain reliefProper use of resources.SIGNIFICANCE

Who needs?TERMINAL ILLNESS ON PATIENT ON FAMILY

IMPACT OF TERMINAL ILLNESS

PHYSICAL REACTIONS*Anorexia*weight loss*chest pain*fatigue*GI disorders*Hair loss *Headache*Immunondeficiency*Agitation*cryingGRIEF*Anger*Anxiety*Apathy*Denial*Depression*Disbelief*Guilt*Hallucinationof the deceaseds presence*Helplessness*IrritabilityPSYCHOLOGICAL REACTIONS

1)Palliative care2)Hospice care3)Home careCOMPONENTS OF TERMINAL CAREIt is the total care of patients &their families by a multi professional team at a time when the patients disease is no longer responsive to curative treatment.

PALLIATIVE CAREProvides relief from painRegards dying as a normal processNeither hastens nor postpones deathSupport systemEnhance quality of lifeTeam approachPRINCIPLES

Symptom reliefPsychosocial supportTeam work

Components of Palliative careHospice provides palliative care services to the terminal patients &care for dying patients.DEFINTIONHospice is an inter disciplinary concept for providing comprehensive care to terminally ill patients.HOSPICE CARECentrally administeredAutonomous programmeSymptom controllTeam workServices extended to familiescharactersticsIt includes arrangements of health related services provided to people in their place of residence.HOME CARELess expensiveMore comfortableContinous careClients prefer to die at home

ADVANTAGESControl of symptoms &family supportComfortableGoals redefinedModification of managementReviewEffective communicationClients assured of their comfortAvoid unnecessary interventions

STANDARDS OF CARE OF TERMINALLY ILL

DOMAINS OF CARE OF TERMINALLY ILL1)Pulmonary impairementCoughDyspneaDeath rattleStridor2)Cardaic dysfunctionHeart failurePeripheral circulation changes

PHYSICAL ASPECTS

3)Central nervous system alterationsDeliriumTerminal anguishTerminal restlessnessHiccoughs4) Renal impairementFrequencyIncontinence5)GI DisturbancesAnorexiaDehydrationNausea& vomitingConstipation Diarrhoea6)Musculo skeletal changes7)IntegumentaryPressure ulcerDepressionDenialAngerAnxietyFear of death/dependenceSuicidePSYCHOLOGICAL ASPECTSSPIRITUAL ASPECTSSOCIAL ASPECTSDeath is an invitable part of glory of lifeCessation of all physical&chemical process that invariably occurs in all organisms.-Miller keene.DEATH & DYING

Decreased level of consciosnessDecreased desire for food &liquidsDecreased urine outputIncontinance Skin dryNoisy breathingSIGNS &SYMPTOMS OF APPROACHING DEATHBreathing,heart beat ,&pulse stop entirelyPerson is unresponsive to shaking/ shoutingPupils dilated &fixedLoss of urine &bowel controlAT POINT OF DEATHRIGHTS OF DYING PATIENTLOSS &GRIEF

DenialAngerBargainingDepressionAcceptanceKUBLER ROSS STAGES OF GRIEFEuthanasiaAdvance directivesLiving willDNRPower of attorneyHealth care surrogateTerminal weaningOrgan donationautopsyETHICAL &LEGAL ASPECTS OF CARE

Kubler rosss stages of grief