CC Week 13: Palliative/EOL Care
Palliative/End of Life Care
Hospice Palliative Care: “care aimed at improving the quality of life of patients with
life-threatening** illness and their families through the relief of pain and suffering” (Tyerman et
al., 2023, p. 206).
**Now, the preferred term in practice is those with a life-limiting illness.
Integrated Palliative Approach: “care focused on meeting a patient’s and family’s full range of
needs– physical, psychosocial, and spiritual– at all stages of illness, not just at the end of life”
(Tyerman et al., 2023, p. 207).
End-of-Life (EOL) Care: “care given during the last months, weeks, or even days of a patient’s
life.” Patients state that quality EOL care must contain trust in the treating physician, avoidance
of unwanted life support, effective communication, continuity of care, and death with dignity”
(Tyerman et al., 2023, p. 207).
Goals of Palliative Care at EOL:
1. Provide relief from pain and alleviate symptoms.
2. Affirm life and neither hasten nor postpone death.
3. Support holistic care to enhance quality of life.
4. Offer support to patients so they can live as independently as possible.
5. Offer support to family members during illness and bereavement process.
6. Regard death as a normal process.
Four Successive Factors of Integrated Palliative Care:
Vision: People:
● Commitment to PCC. ● Dedicated coordinators.
● Focus on building capacity. ● Interdisciplinary team members.
● Change organizational struct. ● Nurses (key)
● Senior management support. ● Networks, Relationships, etc.
Delivery of Care: Supportive Tools:
● Integration of levels of health prom. ● Standards for frameworks, standards, and
● Cultural sensitivity. assessments.
● Advanced care planning. ● Flexible approaches to education.
● Shared records, research, evaluation and
improvement.
, CC Week 13: Palliative/EOL Care
Physical Manifestations of Approaching Death:
Sensory :
hearing , vision taste I smell
,
↳ hearing is usually last to disappear
↳ all senses ↓ disease progression
of eyes
↳ blurred vision; sunken/glazing
↳ absent blink reflex ; eyes may remain
Megamam
half open .
Cardiovascular System:
Respiratory System :
↳ ↑ resprate
↳
Cheyne-Stokes respirations
Laternating periods of apped
followed by deep rapid)
,
↳
inability to coughorclear sear- Gastrointestinal System:
etions
"guppy breaths" eventually
↳
slowing or cessation of motility (may bedue
to opioid usage).
Urinary system : ↳ accumulation of gas distention , nausea
,
↳
gradual ↓ in VO ↳ loss of sphincter control ->
incontinence
↳ incontinence ↳ BM immenintly or right after death.
↳ , or inabilityto void
dyscria
d
musculoskeletal system :
integumentary system
:
↳ ↑ weakness
↳
mottling of hands feet
, , arms ↳gradual loss in abilityto move
and legs ↳ sagging of jaw dit ↓o muscle tone
↳ cold
, clammy
skin ↳ difficulty speaking & swallowing
↳ cyanosis of nailbeds nose, knees
↳ loss of gag reflex
,
↳way-likeSkinappearanceeasier ↳ difficulty maintaining body posture and
alignment
↳
jerking (myoclonus)
to those receiving
high doses of steroids.
Palliative/End of Life Care
Hospice Palliative Care: “care aimed at improving the quality of life of patients with
life-threatening** illness and their families through the relief of pain and suffering” (Tyerman et
al., 2023, p. 206).
**Now, the preferred term in practice is those with a life-limiting illness.
Integrated Palliative Approach: “care focused on meeting a patient’s and family’s full range of
needs– physical, psychosocial, and spiritual– at all stages of illness, not just at the end of life”
(Tyerman et al., 2023, p. 207).
End-of-Life (EOL) Care: “care given during the last months, weeks, or even days of a patient’s
life.” Patients state that quality EOL care must contain trust in the treating physician, avoidance
of unwanted life support, effective communication, continuity of care, and death with dignity”
(Tyerman et al., 2023, p. 207).
Goals of Palliative Care at EOL:
1. Provide relief from pain and alleviate symptoms.
2. Affirm life and neither hasten nor postpone death.
3. Support holistic care to enhance quality of life.
4. Offer support to patients so they can live as independently as possible.
5. Offer support to family members during illness and bereavement process.
6. Regard death as a normal process.
Four Successive Factors of Integrated Palliative Care:
Vision: People:
● Commitment to PCC. ● Dedicated coordinators.
● Focus on building capacity. ● Interdisciplinary team members.
● Change organizational struct. ● Nurses (key)
● Senior management support. ● Networks, Relationships, etc.
Delivery of Care: Supportive Tools:
● Integration of levels of health prom. ● Standards for frameworks, standards, and
● Cultural sensitivity. assessments.
● Advanced care planning. ● Flexible approaches to education.
● Shared records, research, evaluation and
improvement.
, CC Week 13: Palliative/EOL Care
Physical Manifestations of Approaching Death:
Sensory :
hearing , vision taste I smell
,
↳ hearing is usually last to disappear
↳ all senses ↓ disease progression
of eyes
↳ blurred vision; sunken/glazing
↳ absent blink reflex ; eyes may remain
Megamam
half open .
Cardiovascular System:
Respiratory System :
↳ ↑ resprate
↳
Cheyne-Stokes respirations
Laternating periods of apped
followed by deep rapid)
,
↳
inability to coughorclear sear- Gastrointestinal System:
etions
"guppy breaths" eventually
↳
slowing or cessation of motility (may bedue
to opioid usage).
Urinary system : ↳ accumulation of gas distention , nausea
,
↳
gradual ↓ in VO ↳ loss of sphincter control ->
incontinence
↳ incontinence ↳ BM immenintly or right after death.
↳ , or inabilityto void
dyscria
d
musculoskeletal system :
integumentary system
:
↳ ↑ weakness
↳
mottling of hands feet
, , arms ↳gradual loss in abilityto move
and legs ↳ sagging of jaw dit ↓o muscle tone
↳ cold
, clammy
skin ↳ difficulty speaking & swallowing
↳ cyanosis of nailbeds nose, knees
↳ loss of gag reflex
,
↳way-likeSkinappearanceeasier ↳ difficulty maintaining body posture and
alignment
↳
jerking (myoclonus)
to those receiving
high doses of steroids.
