pcu manual palliative care

8/21/2019 PCU Manual Palliative Care

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- ESAS

- PPs

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(Palliative care) " "


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""


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50


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1.

-

- acute delirium

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() 4.


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-


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( ) 4

(dead and dying consulting)


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( )


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cure sometime, comfort often, andcare always

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1.


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6-8

(

)


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1 ? 1

(SpecialMouth Wash)


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4


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2.

2


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()


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(the way of life) ()

-

()

-


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1.

2. ( ) 21 107 "()

"3.

4.


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5. - -()

1. "


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" 26 80 ""

2.2

155 "


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() "

3.

4.


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5.

(Suicide)

(3-4 )

1.

2.( )


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3.

4. 5

5."" () ""

6. "" " " ""

7.""


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8. ()

1.

2.

3.

4.

5.


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1.2.3.4.

()


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...

1."

"

(14:13-14)

"" ""


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2.()" "

" " " " (14:13)

"" () ()

() "" " " ()

""


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3.()"

" (1:23)

(

21:1-4)

""

.


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.

.

- -

() ()


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-

-


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()

-


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-

1.


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2.

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5.


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6.

""


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.

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.

7

7

1


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() () 3


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1.

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()


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....


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/


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.. PDCA /

-


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..

.

.

..


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.. ..

..

..

".."..


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2 1.

()

2.

( )

1.2.3.

4.

..


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5 1.2.

3.4.5.

.. 1. 6

/ /


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2.3.

PDCA (Plan, Do, Check, Act)

4.5.HHC (Home Health

Care) . 6.

(End of Life Care)

7.

24

....

(One Stop Service)


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0-5 6-12 (

)

1.


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2. HomeHealth Care

. -

3.

(End of Life Care)

1. (.. )


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hardware, software one stop service Internet ""

..

..

..

( )


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. .

.. /

2...

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(Geographical InformationSystem : GIS)

24


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()

.

.

24

..


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()

(16.00 -20.00.)


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..- - - - (

)-

- CUP-

.

.- .

- .

-

.... (Home visit, Home health care, Homeward)


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.. /

(Self-care) .

. ,


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1

1.

2.

3.

4.

,


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,

,,

,

/

,


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-

-

- -

- ()- -

2


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3

-

4

2.1, ,

,


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2.2

2.3.

5

(Self-care) 6


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INHOMESSS

(bio

psycho social spiritual) I : (immobility)

(Activities of daily living) , , , ,

(Instrumental activities of daily living), , , ,


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N : (nutrition),

H : (housing),

1

O : (other people)

M : (medication)

E : (examination)

S : (services) ,

.


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S : (safety) , , , ,

S : (Spiritual)

1.


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2.

3.4.

15

BATHE (backgroundsituation),(affect), (troubling for the patient), (handing the problem), (empathy)

5.6.


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1.

2.

SOAP

(subjective) ,, ,

(objective)


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(assessment) (abdominal pain)

active inactive

(plan) ,

active

inactive


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1. ..( .. 2551 5 )

2.

2.1


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..

2.2

2.3()

2.4

2.1

2.2- 372

330


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- 330

1.

2.

3.


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4.5.

6.

7.


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1.


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()


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()

3.


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()

4.

( " ")


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5.


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( )


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" "

6.


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- ""

"

"

1

10

"" ""

()


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()

()() ()3

""


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..


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7.


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" "

""


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.

Idea, Feeling, Function, Expectation - Idea

- Feeling

- Function- Expectation

.

.


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""

..


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.


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""

/////

1.

()


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""

( )

""""

/


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2.

""

/ ""

""

""


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3. "" ()

/ "" ""

"" "" () ()(total parenteral nutrition, TPN) // ""

4.

" "


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/ "" ""

5. /

//

/

/// /

6.


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() /

/

7./

/ ( )

//

/"" /


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/

8./ /

/ () ( ) ( metabolic acidosis)

(death rattle)

( "" 12

2551108 1 )

(AdvancedCardiovascular Life Support, ACLS)


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"" (persistent vegetative

state)

Humanize

NursingCarein

EndofLife


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1. (Care and comfort)

(health illness continuum)

(assesment anddiagnosis)


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2. (health teaching) (Self care)

3. (counseling)

4. (physiopsychosocial

intervention)

:

/

1. ==

=- ( = )


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2. 4

= = =

= 3.

4.


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5.


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:


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%

%

%

%


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ward -


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:

" " ""

()


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"

"

TRUST T = Teamwork


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R = Relationship U = Unity S = Simple / Sincere

T = Take Care Themselves

Verbal Non-Verbal


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-

Underlying Feeling, Conflicts, Wishes


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- anticipatory anxity

- anticipatory grief

- fears (unknown, loneliness, suffering and pain)

, ,,

- psychiatric comorbidities

Reality of loss

- Impending death

- Loss of self control and everything


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Say final goodbyes

- gone for good

- death is nothing

- sense of control (end of life decisions)

-


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Attitude, Knowledge and SkillsAttitude

-

- -- Psychological minded

-

Knowledge

- Psychological reaction

- Coping patterns


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- psychiatric comorbidities Skills

- psychological assessment- communication (verbal, non - verbal)

- mental support jump support

- self - control


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(verbal) (non -verbal)

..

- two - way communication (as aperson)

-

-

I message U message bonding "I message"


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" " "Youmessage" "" "I message"

"" (

"" )

" " "" """You message"

"

"

"

" ""

" " " "

-


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- small talk () free speech

-

-

mental support

-

-

- 3 Hope, Caring, Sharing (HCS)


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- sense of control Sharing attitude , environment ,

communication , responsibility ,experience

-

To cure sometime, To relieve often, To comfort always

()

.


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.

.

.

.

.


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(FamilyMeeting)

"Family Meeting"


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(Family Meeting)

Family Meeting -

-

-

Family Meeting1.Family Meeting

- FamilyMeeting Family Meeting

-

-


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- Genogram Family Meeting

- Facilitator Family Meeting ( Facilitator Family Meeting

)-

-

1

2.-

- FacilitatorFamily

Meeting


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- Facilitator (

Genogram )

3.

-

-

-


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4.

-

- ()

-

-

-

- DNR,(Do Not Recussitate) , ,

,


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5.

-

-

-

6.-

-

-


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.

-

-

.

.


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. - -


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1. ""

()

2./""

3.//

4. acetaminophen

(Paracetamol)

steroids /


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NSAID, non-steroid anti-inflammatory drug/

(antispasmodics)

amitryptytine, imipramine carbamazepine,clonazepam, gabapentin

1

(symphathetic neuro-humoral system) """""


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/

/

prednisolone 5--

1. ("")


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()

2. dimenhydrinate domperidone

metoclopramide ondansetron("")

3.

/ ( )

1.


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2."" diazepam 5-10 IV 10-15

3. (

) haloperidol2.5-5.0 IV 10-15

4.

/

1. ()

( )


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2. () codeine acetylcysteine, ambroxol, bromhexine,carbocysteine

3.() //

/

(death rattle)

(endotracheal tube) atropine hyoscine


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"" "" ""

1.

/

2. ( ) (milk of magnesia, bisacodyl)


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1.//

2.

3./

""


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4.(metabolic acidosis) 3 (IV) 5-10

1.

2.

1-2 ()

3.(0.9% normal saline) metronidazole tetracycline 2 1 3-4


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4. lidocaine prenisolone

()

(bed sores) (chronic ulcers)

(fistula)

/


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//1.//

2.//

" " "" "" ""

///// //


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ESAS(Edmonton

Symptom Ass

essment

System)

ESAS (Edmonton Symptom

Assessment) PPs (Palliative Performance Score)

ESAS

ESAS Edmonton Symptom Assessment

System ()


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ESAS 9 /

0-10

0 10


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ESAS (Edmonton Symptom Assessment System)


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ESAS

ESAS- ESAS

- ()

Thai MMSEESASCognitive impairmentDelirium

-


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-

- 0-10

10

- Cognitive impairment ESAS 10 10

score ESAS

- ESAS 10


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PPS(Palliative

Performance

Scale)

- ESAS Subjective

ESAS (1-5)

PPS

Victoria Hospice Society British Columbia Palliative

Care PPS 11 100%

0% 3 (>70%) (0-30%) 2 (40-70%)


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PPS 5

PPS , 0-40%

,

PPS


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Palliative Performance Scale (PPSv2)

** .

ECS-CP (Edmonton Classification System for Cancer Pain)

ECS-CP Classification


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5

1.(neuropathicpain) neuropathic pain

2.(incident pain)

around the clockopioidtoxicity

3.

Physical pain


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counselingpsychological intervention

4.

5.(Cognitiveimpairment)

aphasia

TNM staging (Tumor, Nodes and Matastases)


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Validity Validity inter-rater reliability

ECS-CP- ECS-CP

-

ECS-CP

- ECS-CP

- x


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(N x) ECS-CP


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Palliative Performance Score

Flow Chart Palliative care


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(Power of Attorney) (Power of Attorney)


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1. (Stages ofdisease, Prognosis)

2. ""Living will

3.


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4.

5.empathy

6.


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""


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""

42 45

Online

10


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"

"


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.2

3

8


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, Crystal bowl, ,

3

CA Lung


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Crystal bowl,

3


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-

""

"

"


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End of Life Care Improving Care of

The Dying(2550), 2

(1987) () () (2544),

On Living and Dying,

2

(2549),

, 2


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, 3

(2550),

:

, 1

() ()

(2545), , 4

.

() ()

(2549),

THE TIBETAN BOOK OF LIVING AND DYING , 4

() ()

(2550),

THE TIBETAN BOOK OF LIVING AND DYING (PART I LIVING)

(2248) ,

,.

1


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: (2548), 2

(2549),

, 2

, (2548),

,(2551): ,

(2552), Friendship

Support1 .

, (2553),1,

1

(2551)

,

() ()

(2547), ,

() Graceful Exits,1 (2547)

.


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(2550),

, ,

pcu manual palliative care

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