Page 29 - Delaware Medical Journal - April 2017

PALLIATIVE CARE
would not be able to be discharged with that level of support. Her daughter was present and, as she was already on hospice,
it was thought that the patient and her family understood her current grave condition. The patient was presented options on how she would be able to transition home. The palliative care team explained that she would be able to go on Bilevel Positive Airway Pressure during transport, and then change over to oxygen via nasal cannula (NC) and be medicated at home for air hunger until her natural time of death. The look of shock was immediate. She stated, “I am dying?”
Palliative care addresses the physical, psychosocial, and spiritual needs of the patient.
At this time, it was determined that no one had explained to
the patient or her family what was happening. It was assumed that she wanted to go home to die because she said that she
did not want aggressive measures, and that she wanted to be
on hospice. After a lengthy discussion on goals and what the patient wanted, she was transferred off of hospice, admitted
as an inpatient, and a CT scan was ordered to determine the source of her acute respiratory distress. The next day the patient had a thoracentesis, in which 1 L was removed, allowing her to breathe easier, and decrease oxygen needs to 2 L via NC. The patient was discharged home on hospice, not to die, but to live out her days with quality.
Symptom management is another major aspect of palliative care. An estimated 90 million Americans are living with serious, chronic illnesses such as cancer, respiratory disorders, heart disease, and dementia.3 Pain, when associated with serious With the changes in regulations regarding opioid prescribing,
it is even more important to understand how to use these drugs safely and effectively. Complex pain robs patients of quality of life and contributes to anxiety, depression, and stress. Palliative care addresses these symptoms as well as dyspnea, nausea, vomiting, and constipation.
Palliative care specialists address the whole person when doing an initial assessment. The assessment includes not only the diagnosed disease and symptoms associated with that disease, but also how the patient is coping with the diagnosis. Palliative care addresses the physical, psychosocial, and spiritual needs of the patient. It is often during crisis that a patient is in most need of spiritual support, and during a normal assessment, it
is rarely addressed. Palliative care teams support not only the patients, but the medical team as well. Doctors and nurses battle moral distress on a consistent basis. This often occurs in critical care areas where futile treatment is provided due to lack of understanding on the part of the family. Palliative care provides support to the staff by intervening with family members, having goals that often result in discontinuing the futile treatment. This can provide compassionate care to the patient and family, as well as to the medical staff.
Palliative care has been shown to increase patient and family satisfaction, improve quality, and extend survival. In addition to all the positive effects it has on patient care, it has been shown to be a cost-saving endeavor by providing high-quality care and avoiding unwanted and expensive crisis care.
CONTRIBUTING AUTHOR
■ THERESA LATORRE-TEGTMEIER, MSN, APRN, FNP-C is a Palliative Care Nurse Practitioner at Bayhealth in Dover Del.
REFERENCES
1. Center to Advance Palliative Care (CAPC). Definition
of Palliative Care. Available at: https://www.capc.org/ search/?q=palliative+care+definition. Accessed February 23, 2017.
2. Goldberg GR, Gliatto P, Karani, R. Effect of a 1-week clinical rotation in palliative medicine on medical school graduates’ knowledge of and preparedness in caring for seriously ill patients. J Am Geriatr Soc. 2011;59,1724-1729.
3. Center to Advance Palliative Care (CAPC). Symptom Management. Available at: https://www.capc.org/topics/pain-management-palliative- care/. Accessed February 23, 2017.
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