Essential Components of

Palliative Care
Essential Components of Palliative Care

Hope
SYMPTOM PSYCHOLOGICAL
SUPPORT
REIEF Honesty

Openness

TEAM WORK &

PARTNERSHIP
CARE OF THE DYING STANDARDS FOR HEALTHCARE IN
PROVIDING END-OFLIFE CARE

1. Providing appropriate treatment for any primary and

secondary symptom, according to the wishes of the
patient and surrogate decision maker
2. Managing pain aggressively and effectively.
3. Sensitively addressing issues such as autopsy and
organ donation
4. Respecting the patient’s values, religion, and
philosophy.
5. Involving the patient and the family in every aspect of
care.
6. Responding to the psychological, social, emotional,
spiritual and cultural concerns of the patient and family.
 CARE OF THE DYING:
BENEFITS OF GOOD NURSING CARE SO PATIENT DIE
WITH DIGNITY AND COMFORTABLY

1. Attention to pain and symptom control

2. Relief of psychological distress
3. Coordinated care across setting with high quality
communication between health care providers
4. Preparation of the patient and family for death
5. Clarification and communication of goals of
treatment and values
6. Support and education during the decision-making
process, including the benefits and burdens of
treatment.
 PALLIATIVE CARE
GOAL: to prevent and relieve sufferings and to
support the best possible quality of life for patients
their families

• both a philosophy of care and an organized

highly structured system delivery of care
• provided to older patients who have: - acute,
serious, life-threatening illness (stroke,
trauma,MI,cancer) progressive chronic illness (end
stage dementia,CHF, renal or liver failure)
• may take place in the hospitals, in outpatient
clinics, in long term care facilities or in home
 HOSPICE CARE
• The support and care for persons in the last
phase of an incurable disease so that they
may live as fully and comfortably as possible
• Medicare hospice benefit was designed to support
dying patients with less than 6months to live
focuses on the whole person by caring for the
body, mind and spirit
• Hospice care nurse assesses the patients and
family’s coping mechanisms, the available
resources to care for the patient, the patient’s
wishes and the support system in place
 ALTERNATIVE CARE
• Traditional medicine may share spotlight
with acupuncture, massage therapy,
chiropractors and herbal medicines
• National Institutes of Health initiated the National
Center for Complementary and Alternative
Medicine
• (NCCAM) – is dedicated to explore
complementary and alternative medicine.
 COMMON FEARS AND CONCERN OF
THE DYING
1. Death itself
2. Thought of a long and painful death
3. Facing death alone
4. Dying in the nursing home, hospital, or rest home
5. Loss of body control, such as bladder or bowel
incontinence
6. Not being able to make decisions concerning care
7. Loss of consciousness
8. Financial costs and becoming burden on others
9. Dying before having a chance to put personal affairs in
order.
 NURSE’S ROLE
• Will assume the role of a clinician (expert
clinician)
• The nurse will carry out a complete
physical, psychological, social, and
spiritual assessment and design a plan of
care (in collaboration with the patient,
family & interdisciplinary team) to meet the
needs of the older patient.
 PAIN RELIEF AT THE END OF
LIFE
1. Providing the initial and ongoing assessment of levels of
pain, administration of pain meds, and evaluation of the
effectiveness of the pain mgt plan
2. PAIN the 5th vital sign – must be routinely carried out
when other v/s such as the temp, pulse, RR, BP are
assessed.
3. Pain hasten death and is associated with needless
suffering at the end of life
4. The provision of culturally sensitive care is a necessary
component of effective and comprehensive end-of-life care
5. Pain is a subjective experience.
6. Self report is the gold standard for measuring pain.
If the patient can’t speak or cognitively
impaired, nurse should carefully observed
for:
• Moaning, groaning at rest or with
movement
• Failure to eat and drink
• Grimacing or strained facial expression
• Guarding or not moving body parts
• Resisting care or noncooperation with
therapeutic interventions
• Rapid heartbeat, diaphoresis or change in
V/S
 EFFECT OF PAIN DURING
THE DYING PROCESS
• Increasing physiological stress, potentially
diminishing immunocompetency
• Decreasing mobility: worsening risk of
pneumonia and thromboembolism
• Increasing the work of breathing and myocardial
oxygen requirements
• Unrelieved pain at the end of life can cause
psychological distress to the patient and family
and associated with negative outcomes such as
sufferings and spiritual distress
 EFFECT OF PAIN DURING
THE DYING PROCESS
• Increasing physiological stress, potentially
diminishing immunocompetency
• Decreasing mobility: worsening risk of
pneumonia and thromboembolism
• Increasing the work of breathing and myocardial
oxygen requirements
• Unrelieved pain at the end of life can cause
psychological distress to the patient and family
and associated with negative outcomes such as
sufferings and spiritual distress
 PHARMACOLOGICAL
APPROACH
• Non-opioids - acetaminophen and NSAIDS.
– Effective for mild to moderate pain.
• Opioids –Codeine, MOSO4, methadone
– Block the receptor of the CNS
• Adjuvant drugs – muscle relaxants,
corticosteroids, anticonvulsant,
antidepressants and topical meds enhance the
effectiveness of other classes of drugs
NURSING CARE AT THE END
OF LIFE
• Personal hygiene (top priority)
Oral is crucial – oral swabs, soothing ointment or
petroleum jelly
• Eye care – provided to promote comfort.
Artificial tears or ophthalmic saline solutions to prevent
drying of the eyes
• Anorexia and DHN - a benefit of DHN is decreased lung
congestion, which prevents noisy or labored respirations
• Skin integrity should be monitored carefully to prevent
complications. Lotions, repositioning patient, avoid
shearing forces, use of lift sheets
NURSING CARE AT THE END
OF LIFE
• Personal hygiene (top priority)
Oral is crucial – oral swabs, soothing ointment or
petroleum jelly
• Eye care – provided to promote comfort.
Artificial tears or ophthalmic saline solutions to prevent
drying of the eyes
• Anorexia and DHN - a benefit of DHN is decreased lung
congestion, which prevents noisy or labored respirations
• Skin integrity should be monitored carefully to prevent
complications. Lotions, repositioning patient, avoid
shearing forces, use of lift sheets
NURSING CARE AT THE END OF
LIFE
1. Bowel and bladder incontinence
– protective pads to prevent decubitus ulcer
- Avoid use of catheter because of UTI.
- Constipation should be treated with stool softeners
2. Visual or auditory hallucinations – family members maybe
upset. It is believed that the sense of hearing is intact in
comatose patient.
3. Encourage family members to “let go” and give the terminal
patient permission to die.
4. Appropriate affection should be encouraged and privacy
provided.
5. Read a poem, tell a joke, listen to past story sing a song,
provide a hug.
 PREPARING FOR DEATH
1. Watching the patient decline and the body itself starting
to shutdown life process can bring helplessness and
anxiety.
2. Nurse must help alleviate the fears and anxiety of the
patient and family
3. Questions of an afterlife, unresolved emotional or social
issues, acceptance of death and financial matters are
common.
4. Nurse must support themselves thru this difficult period
and recognize and accept feelings
5. Older patients need reassurance from their relatives
that all is well and it is OK to let go
 POST MORTEM
1. When respirations cease, manually check
breath sounds and heart sounds
2. Check the eyes for pupillary light reflex
3. Note the time of the occurrence of death and
chart
4. Notify the physician, family members and
express condolences
5. Notification comes a shock and needs to be
handled gently and with empathy, allow relative
sufficient time to spend with the deceased
ACTUAL POST MORTEM CARE
1. Needs to be done promptly, quietly, efficiently and with
dignity.
2. If possible before death occurs the limbs should be
straightened and the head placed on a pillow.
3. If autopsy is to be done, the body should be left
undisturbed.
4. Do not secure or tie any body parts as this cause
indentations, body tags.
5. Place a clean gown, insert dentures.
6. Prepare the necessary papers, charting
7. Call morgue, funeral home or other personnel for the
removal of the body from the facility.