Self Directed Learning Package - University of Queensland

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100 • The Palliative Approach ToolkitEnvironmental strategies 19• lighting appropriate to time of day – windows with a view to outside, curtainsand blinds open during the day, and minimal lighting at night• quiet environment especially at night• provision of clock and calendar• avoid room changes• encourage family and friends to be involved in resident care• encourage family to bring in resident’s personal and familiar objects• staff caring for residents with delirium should establish a communication strategythat incorporates elements of both reality orientation and validation techniques• modify the environment to minimise risk of injury (nurse in a low bed with cot sidesdown, bed against the wall, potential hazards such as beside tables removed)• allow family members to stay with resident including overnight• endeavour to have the same staff members care for the resident during andacross shifts• information regarding the diagnosis, cause and management plan should becommunicated to the resident and their family.Clinical practice strategies 19• encourage/assist with eating and drinking to ensure adequate intake• ensure that residents who usually wear hearing and visual aids are assisted to usethem• regulation of bowel function – avoid constipation• encourage and assist with regular mobilisation unless the residents conditiondoes not warrant this• encourage independence in basic ADLs unless the residents condition does notwarrant this• medication review• promote relaxation and sufficient sleep – can be assisted by regular mobilisation,massage, encouraging wakefulness during the day• manage discomfort or pain• provide orienting information including name and role of staff members• minimise use of indwelling catheters• AVOID use of physical restraints• use interpreters and communication aids with CALD patients.Medications 19The primary aim of medications for delirium is to reduce theresident’s distress by targeting any agitation or hallucinations.Antipsychotic drugs are considered first line therapye.g. haloperidol, risperidone or olanzapine.Benzodiazepines do not improve cognition but may helpassociated anxietye.g. short acting agents such as lorazepam or midazolam areusually indicated.Key PointBenzodiazepines may worsen delirium if not used incombination with an antipsychotic drug.When all else failsSometimes agitation and delirium can cause such severe distressand does not respond to medical management, especially in theterminal phase. This is a challenging problem and may requiresedation as the only appropriate intervention.ActivityPlease spend some time reading the section on deliriumin “Therapeutic Guidelines: Palliative Care (version 3)” -included in the PA Toolkit.
101 • Self Directed Learning Package - Advanced Registered & Enrolled NurseEnd of life carepathwayTerminal care is focused on the final days or weeks of life. The Residential Aged Care End of Life CarePathwayThinking PointThe Residential Aged Care End of Life Care Pathway (RACIn the final scenes of the DVD “All on the same page”Alfred is dying.Think about a resident you have cared for who wasapproaching the last weeks of their life.Did everyone involved (family, nurses, careworkers, care in place.GP) agree or understand that the resident was dying?What was it about the resident that led you to believe detail essential steps in the care of patients with a specificthey may die soon?clinical problem. In the case of the RAC EoLCP the specificclinical problem is terminal care.Diagnosing dyingActivityResidents may experience some or all of the following whenThe “PA Toolkit: Forms CD” has a copy ofthey are approaching death and requiring terminal care:the Residential Aged Care End of Life Care Pathway.1. rapid day to day deterioration that is not reversibleYou might like to refer to this copy as you work2. requiring more frequent interventionsthrough this section.3. becoming semi-conscious with lapses into unconsciousnessThinking Point4. increasing loss of ability to swallow5. refusing or unable to take food, fluids or oral medicationsIf yes, what benefits have you seen in your practice6. irreversible weight lossand those you work with?7. an acute event has occurred requiring revision oftreatment goalsBenefits of using the RAC EoLCP8. profound weakness• promotes evidence and consensus-based, best practice9. changes in breathing patterns. 3 palliative careEoLCP) is a document designed to help make consensus basedbest practice care possible for residents at the end of life. It isintended to support residential aged care facility staff in theirefforts to ensure those dying will do so with the best availableCare pathways are structured multidisciplinary care plans whichHave you used this pathway in your clinical practice?• provides documented evidence of care as it is delivered• ensures high quality, standardised care for all residents• supports internal quality assurance and audit processes.
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Self Directed Learning Package - University of Queensland

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