we can do palliative care

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We Can Do Palliative Care... .

palliative care+concept + / / hospice

Continuum of Palliative Care

Symptom Disease Distress Discomfort DysfunctionDxDisease RxPalliative RxDeathDying

Person with illnessFamilyCaregiverBereavement

3

Advance care plan

3 6 [1] #1. Patient preference '%%&*7 "6 D"

= "#%()*7 G)%& 87"#%&*

7$;& ()*!& =&9$

& + &+'7% *&*2

*;=>

#&"87! #& "71 #~011

LIFESS

LIFESS

LIFESS

LIFESS

LIFESS

LIFESS

LIFESS

community family 1.2.3.4.5. (patients suffering)..... cancer pain

Idea(): .....................................................................................................................................................................

Feeling():

Function:

Expectation():SATIR

Kublers Ross stage

PPS ESAS

PCM

ConsciousnessUnconsciousnessBehaviourFeelingPerceptionExpectationYearningSelfCognitive-Behaviour Linkage

SATIR

22

I state You state

Kubler-Rosss Stages of DyingStage I :Shock & Denial No, not meStage II : Anger Why me?Stage III : Bargaining Yes me, but..Stage IV: Depression Yes, meStage V :AcceptanceMy time is very close now, and its alright

25 1. (Shock & Denial) 2. (Anger) 3. (Bargaining)/ 4. (Depression) 5. (Acceptance)

Kubler-Rosss Stages of DyingStage I :Shock & Denial No, not meStage II : Anger Why me?Stage III : Bargaining Yes me, but..Stage IV: Depression Yes, meStage V :AcceptanceMy time is very close now, and its alright

26 1. (Shock & Denial) 2. (Anger) 3. (Bargaining)/ 4. (Depression) 5. (Acceptance)

Kubler-Rosss Stages of DyingStage I :Shock & Denial No, not meStage II : Anger Why me?Stage III : Bargaining Yes me, but..Stage IV: Depression Yes, meStage V :AcceptanceMy time is very close now, and its alright

27 1. (Shock & Denial) 2. (Anger) 3. (Bargaining)/ 4. (Depression) 5. (Acceptance)

Kubler-Rosss Stages of DyingStage I :Shock & Denial No, not meStage II : Anger Why me?Stage III : Bargaining Yes me, but..Stage IV: Depression Yes, meStage V :AcceptanceMy time is very close now, and its alright

28 1. (Shock & Denial) 2. (Anger) 3. (Bargaining)/ 4. (Depression) 5. (Acceptance)

Kubler-Rosss Stages of DyingStage I :Shock & Denial No, not meStage II : Anger Why me?Stage III : Bargaining Yes me, but..Stage IV: Depression Yes, meStage V :AcceptanceMy time is very close now, and its alright

29 1. (Shock & Denial) 2. (Anger) 3. (Bargaining)/ 4. (Depression) 5. (Acceptance)

PPS

community family:...........................................................................................................................................Family system: Family Life cycle:

Family stress/problem:

Family coping:

Family resource:

Impact on health:

community family:...........................................................................................................................................Family system: Family Life cycle:

Family stress/problem:

Family coping:

Family resource:

Impact on health:

caregiver

36

(Care of caregivers)

-Care: -Affection: -Rest: -Empathy: -Goal of care: -Information: -Ventilation: -Empowerment: -Resources:

(Caregiver burden)(Caregiver burden)(Caregiver burnout)

community family

caregiver

Family meeting

44

Family Meeting

community familyPt.&Family role:

Resource:

HSS:

Work/School:

Culture:

Religion:

.

:...........................................................................................................................................Family system: Family Life cycle:

Family stress/problem:

Family coping:

Family resource:

Impact on health: Pt.&Family role:

Resource:

HSS:

Work/School:

Culture:

Religion: 1.2.3.4.5. (patients suffering)..... cancer pain

Idea(): .....................................................................................................................................................................

Feeling():

Function:

Expectation():

( ) 1. PPS score, ESAS( ) 2.Empower ( ) 3. .............................................................................................................................................................................................................................................................................................( ) 4. ......

( ) 5.(the last hour of life) ( ) 6. empower(care giver) *** caregiver*** ADVANCE CARE PLANPatient preference ()( ) ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................( ) .................................................................................................................................................................................................................................................................................................................................... ( ) ..................................................................................................................2. Advance directive (/ ) **** Living will******

3. Proxy nomination ( ) (power of attorny).................................................................................................................................................................

( ) 5.(the last hour of life)

Last Hours of Life Multiple organ failure Catabolic stage Energy preservation stage

49

Signs of Dying1. ,,, 2. -

3. -Q1H( 1 .+ 1/2 . + baking soda 1.) QID4.

Signs of Dying

5. Lorazepam(0.5) Q1/2HPhenobarb gr. I Q1H6. ApneaCheyne-strokes(acid)Air HungerO2 Signs of Dying

7. , O2 & suctionScopolamine patch8. BP,Pulse( )Signs of Dying

54

community family

GRIEF

55

PALLIATIVE CARE

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