c1, c2…continuing the conversation: what is critical in
TRANSCRIPT
![Page 1: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/1.jpg)
Lorelei Sawchuk, RN, MN, CHPCN(C)Nurse Practitioner & SupervisorPalliative Care ProgramRoyal Alexandra HospitalEdmonton, [email protected]
24th Annual Palliative Care ConferenceEdmonton, AB
C1, C2…Continuing the Conversation: What is CRITICAL in providing comfort care?
![Page 2: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/2.jpg)
2
Conflicts of Interest Declaration
• None
![Page 3: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/3.jpg)
3
Objectives
• Utilizing the RMC Goals of Care Designation, the healthcare professional working at a patient’s beside will be able to:– Translate the care needs of palliative patients
designated as C1 or C2 level of care
“What is expected and what do I do when C1 or C2 care is prescribed?”
![Page 4: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/4.jpg)
4
Advanced Care Planning & Goals of Care Resources
• Conversations Matter Video Series• Conversations Matter Guidebook• Healthcare Professionals
– Goals of Care Order Form– Advanced Care Planning Tracking Record– Quick Reference Pocket Card
http://www.albertahealthservices.ca/3917.asp• E-Learning Modules
http://www.albertahealthservices.ca/4254.asp
![Page 5: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/5.jpg)
5
Purpose of Goals of Care Designations
• To reflect a patient’s values & beliefs regarding: – Care to receive– Location of care
Alberta Health ServicesAdvance Care Planning: Goals of Care Designation (Adult) PolicyRMC: Understanding the Goals of Care Designations
![Page 6: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/6.jpg)
6
Where & How We Choose to Die
![Page 7: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/7.jpg)
7
Common Symptoms at End of Life
• Pain• Tiredness (Lack of Energy)• Drowsiness (Feeling Sleepy)• Nausea• Lack of Appetite• Shortness of Breath (Dyspnea)• Depression (Feeling Sad)• Anxiety (Feeling Nervous)• Wellbeing (How you feel overall)
![Page 8: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/8.jpg)
8
Common Hospital Interventions• Imaging: Xray, CT, MRI…• Intravenous• Oxygen• Blood Tests• Medication
– Pills– Needles
• Vital Signs• Rehabilitation• Repositioning in bed• Toileting
– Voiding & bowel movements• Nutrition
![Page 9: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/9.jpg)
9
Overview of RMC
• R– Medical care & interventions include resuscitation
followed by ICU to cure or control of illness• M
– Medical & interventions to cure or control health condition without resuscitation or ICU
• C– Medical care & interventions without cure or control
of health condition– Maximal symptom control & maintenance of function Alberta Health Services
Advance Care Planning: Goals of Care Designation (Adult) PolicyRMC: Understanding the Goals of Care Designations
![Page 10: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/10.jpg)
10
Dialysis
![Page 11: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/11.jpg)
11
C Level of Care• Medical care & interventions focused on comfort• Care aimed at maximum symptom control &
maintenance of function without cure or control of illness• C1: Transfer may be possible to better understand or
control symptoms including surgery• C2: Physical, psychological & spiritual care anticipating
imminent death (hours to days). Do not usually transfer for care needs
Alberta Health ServicesAdvance Care Planning: Goals of Care Designation (Adult) PolicyRMC: Understanding the Goals of Care Designations
![Page 12: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/12.jpg)
12
Surgery
![Page 13: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/13.jpg)
13
Painful Bone Metastasis
• Radiation
![Page 14: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/14.jpg)
14
Pleural Effusions
• Thoracentesis
• PleurX
![Page 15: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/15.jpg)
15
Ascites
• Paracentesis
• Abdominal PleurX
![Page 16: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/16.jpg)
16
Infections
![Page 17: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/17.jpg)
17
M2 vs C1: The Role of Antibiotics
• http://www.albertahealthservices.ca/ps-1023351-acp-faq-clinical.pdf
• “By way of example, a person with an M2 designation who develops a new pneumonia would receive treatment aimed at cureof the pneumonia, but only in the current location of care. A person with a C1 designation who develops pneumonia might seek treatment that would relieve potential pain, dyspnea and distress, whether or not the treatment could fully resolve the pneumonia. Sometimes antibiotics would be contemplated for such a patient, with the sole intent of relieving symptoms.”
![Page 18: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/18.jpg)
18
Transfusions
• How would this help?• What would the
concerns be?
![Page 19: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/19.jpg)
19
Intravenous
• Antibiotics
• Diuretics
![Page 20: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/20.jpg)
20
PICC Lines
![Page 21: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/21.jpg)
21
Blood Tests
• Always ask…will this make the person more comfortable in easing symptoms
![Page 22: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/22.jpg)
22
Blood Glucose Management
![Page 23: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/23.jpg)
23
Less Painful Pokes
• IM or Subcut • EZ Set Butterfly
![Page 24: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/24.jpg)
24
HDC Pneumothorax
![Page 25: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/25.jpg)
25
How thirsty are you?
![Page 26: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/26.jpg)
26
Artificial Hydration
Why?• Prolong life?• Can improve comfort by
preventing toxic effects caused by pain medication
• Can ease the worries of the family
Why not?• Prolong life?• Decrease phlegm (respiratory
secretions)• Decreases breathing problems
from heart failure & fluid in the lungs (pulmonary edema)
• Reduce swelling (edema)• Does not help a dry mouth • Does not help thirst if mouth is
well cleaned and moistened
![Page 27: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/27.jpg)
27
Hypodermoclysis (HDC) “Clysis”
• IV fluids given through a small needle into the fatty (subcutaneous tissue) just under the skin
• Little worry if accidentally pulled out
![Page 28: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/28.jpg)
28
By Mouth
• By spoon• By sponge• By straw• Sips• At risk
![Page 29: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/29.jpg)
29
Mouth Care
![Page 30: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/30.jpg)
30
Artificial Nutrition
![Page 31: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/31.jpg)
31
Management of Agitation
• Restrain (yourself)• Calmness• Chemicals
– Haloperidol– Methotrimeprazine– Midazolam
![Page 32: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/32.jpg)
32
Oxygen
![Page 33: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/33.jpg)
33
Medication
![Page 34: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/34.jpg)
34
![Page 35: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/35.jpg)
35
![Page 36: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/36.jpg)
36
![Page 37: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/37.jpg)
37
Medication Review• Acetaminophen 650 mg po QID• Centrum Forte 1 tab po Daily• Enalapril 10 mg po BID• Folic Acid 5 mg po Daily• Heparin 5000 units SC q12H• Lasix 40 mg po QAM• Metformin 850 mg po BID• Morphine ER (Long acting) 60 mg
po BID• Pantoprazole 40 mg po daily• Peg 3350 packet 17G po QAM• Prednisone 7.5 mg po Daily• Rosuvastatin 10 mg po Daily• Vitamin B6 25 mg po QHS
• Maxeran 10 mg po/SC Q6H PRN• Morphine 5 mg SC Q4H PRN• Zopiclone 3.75 mg po QHS PRN
![Page 38: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/38.jpg)
38
Vital Signs
![Page 39: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/39.jpg)
39
Skin Care
• Resposition• Resist
![Page 40: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/40.jpg)
40
Voiding
• Bathroom• Commode• Bedpan• Incontinence products• Texas condom catheter for men• Foley catheter• Monitor for urinary retention!
![Page 41: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/41.jpg)
41
Bowel Care
![Page 42: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/42.jpg)
42
Peace & Privacy?
• Preference• Communication!
![Page 44: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/44.jpg)
44
![Page 45: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/45.jpg)
45
Summary
• Goals of Care are– Not contracts – Conversations– Opportunities to share concerns and wishes
![Page 46: C1, C2…Continuing the Conversation: What is CRITICAL in](https://reader034.vdocument.in/reader034/viewer/2022042723/586cc7c11a28ab0b6b8bdb91/html5/thumbnails/46.jpg)
46
Lorelei Sawchuk, RN, MN, CHPCN(C)Nurse Practitioner & SupervisorPalliative Care ProgramRoyal Alexandra HospitalEdmonton, [email protected]
24th Annual Palliative Care ConferenceEdmonton, AB
C1, C2…Continuing the Conversation: What is CRITICAL in providing comfort care?