Self Directed Learning Package - University of Queensland

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160 • The Palliative Approach Toolkit6. You are asked to help Bob shower this morning. You should rush him and get it over as quick as possiblethen he can take the rest of the day to recover.• Residents with dyspnoea benefit from having a preventative plan of care that decreases the distress andanxiety of dyspnoea before it occurs.• Bob might take a small dose of opioid medication (e.g. morphine) at least ½ hour before showering (morphinecan be effective for breathless as well as pain).• Don’t rush or hurry Bob and allow rest periods during activities (decreases his need for oxygen andreduces anxiety).• In the bathroom, leave the exhaust fan on and make sure the shower water is deflected away from his face(prevents claustrophobia).TrueFalseSection 27. Family members have the right to determine if a resident should attend a palliative care case conferenceon the grounds that ‘it will only upset him/her’.• As careworkers our primary role is to provide resident centred care which includes advocating on the resident’s behalf.• Perhaps the resident would be upset about what is discussed, but it is up to them (while they are cognitivelyable to make decisions competently) to decide whether they will attend.• Most residents choose to attend case conferences and can provide insights into their condition that family andstaff may not have known about otherwise.• If a resident is likely to become distressed or fatigued, consider holding the case conference in their room wherethey can rest on the bed. Ask their permission to continue the discussion elsewhere with theremainder of those attending.8. Regardless of the language a resident speaks or where they were born their care needs are the same whenthey are dying.• All residents require careful assessment to ensure that assumptions are not made about cultural needs basedon a resident’s language, religion or country of origin. Similarly, the care needs for members of our indigenouspopulation (Aboriginal and Torres Strait Islanders) requires careful assessment and planning.9. If a competent resident tells you they have pain, is it good practice to ask how severe it is on a scale of 0 to 10.• The use of horizontal or vertical pain scale which asks the person to rate 0 (no pain) or 10(worst pain possible) is good practice to assess pain for compentent residents who do not have severe cognitiveimpairment e.g. advanced dementia.10. Facial expressions and vocalisations can indicate if a resident is experiencing pain.• The Abbey Pain Scale lists whimpering, groaning, and crying as possible indicators of pain.
161 • Self Directed Learning Package - Careworker11. A resident commenced on opioid medicines such as morphine is likely to become addicted and themedication may not work later on as they become tolerant to its effects.• Some strong analgesics are called opioids e.g. morphine, oxycodone or fentanyl.• Sometimes residents or their family members may be concerned about these medications. It is important toknow that when used correctly they:- do not lead to addiction or dependence- do not hasten death- are not just for when the resident is dying.TrueFalse12. Every resident who cannot eat or drink should be fed through a tube (e.g. PEG gastrostomy).• There is no evidence that tube feeding prolongs life, improves comfort or quality-of-life, prevents aspirationpneumonia, leads to better nourishment or decreases the risk of pressure sores.• Although artificial hydration can be useful to treat reversible causes of dehydration, it is not normally usedwhen a resident is expected to die within 48 - 72 hours.13. Lemon and glycerine swabs can be used when a resident has a dry mouth.• Do not use mouthwashes and swabs containing:- lemon and glycerine- sodium bicarbonate (high strength)- preparations containing alcohol or hydrogen peroxide- pineapple or other juices.14. Urinary tract infections can bring on a delirium.• Urine infections are a common cause of older people becoming confused.15. A combination of changes in breathing patterns, decreased consciousness and irreversible weight lossmay be signs of approaching death.A combination of changes in breathing patterns, decreased consciousness and irreversible weight loss may besigns of approaching death.Three or more of the following indicates an End of Life Care Pathway may be appropriate and that the residentis likely to be approaching death:• rapid day to day deterioration that is not reversible• requiring more frequent interventions• becoming semi-conscious with lapses into unconsciousness• increasing loss of ability to swallow• refusing or unable to take food, fluids or oral medications• irreversible weight loss• an acute event has occurred requiring revision of treatment goals• profound weakness• changes in breathing patterns.
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Self Directed Learning Package - University of Queensland

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