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18 Cards in this Set
- Front
- Back
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5 years before death |
Announcement of illness Remissions and fighting Acceptation of reality Comes to the hospital not to be cured, but to cope with symptoms Affect on physical integrity Lack of social integrity = place in society? Psychological suffering - dependent on others Relational suffering - members of family are less accessible Still requires stimulation of senses |
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3 months before death |
Identity crisis New priorities Comfort required Needs help for ultimate expression of self MORE DEPENDENT: falls more frequent, takes medications Palliative follow up begins (2x/week) |
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3 months before death (physical changes) |
Progressive anorexia, dysgeusia (lack of taste), increase in caloric needs --> denutrition glucose, calories and endorphines = natural antidepressants, w/out = depression, fatigue --> naps during the day Épanchement (irritation of serosa), bleeding, chronic inflammation (TnF, IL2), anemia, dyspnea PAINS --> opiates --> CONSTIPATION --> suppositories |
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1-2 months before |
Universe = bed Psychomotor slowing Routine is comforting, few social contacts Fatigue progresses (anemia, denutrition) Change in colour --> yellow, pale (anemia, jaundice) Sleeps when not stimulated Eats less and less, reflux, low immunity Metabolic needs still increase. Decrease in albumin/lactose/glucose to feed the cancer, weight loss Decrease in muscles - difficulty breathing, less peristalsis = less absorption, less balance, inefficient coughing |
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Cancer metabolism |
Requires glucose since it doesn't have mitochondria of its own Glucose comes from muscle catabolism = loss of mobility, breathing, peristalsis (constipation) Uses up albumin, consumes 500g muscle/day Contraction of LEC, hyponatremia Synthesis of CA 125, CA 19-9, CAE, -foetoprotéine, CRPA
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Decadron |
Hyperglycemia, urea Proximal muscle loss, inability to stand up from chair Increased proteolysis Patient feels stronger DIMINISHES INFLAMMATION |
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Stroke |
Hypercoagubility and more platelets Growth factors Thrombophlébite left (heparin to treat) Limits mobility |
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1 month before death |
Lower endorphins = more pain Production of water and retention (through muscle destruction) --> oedema, swelling of metastasis, adjustment of opiates and morphine DISORIENTATION, hypoactive delirium, sees flies Dysphagia, atonia of stomach, hypothyroidism (cold, constipation) T4 --> T3 transformation is deficient Immune deficiency due to decrease in endorphins = candidia in mouth |
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3 weeks before death |
Weird dreams Progressive disorientation Myoclonia + agitation --> transfer to palliative care Rotation of opiates (morphine for hydromorphone) = accumulation of metabolites |
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10-15 days left |
Swan Song: good conversations, last goodbyes, transmission |
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Less than 1 week |
Becomes delirious again Endorphins are really low - pain just moving MORE opiates inversion nycthémérale (sleeps during the day) Cough is no longer efficient, uses accessory muscles to breathing No more NO through breathing --> can't maintain proper perfusion in lungs --> aspirations in lungs Panic + protocol for respiratory distress More proteolysis, oedema CO2 production decreases = pauses in breathing PNEUMONIA |
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1-2 days |
Agitation protocol Comatose Endorphins at 0 Cheynes-Stokes breathing Glassy eyes Rales terminaux |
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12 hours |
No radial pulse Breathing breaks become longer and longer Cold members Skin changes colour (pale, grey) Transpiration (hypotension) Marbling of skin, cyanosed hands and feet |
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6 hours |
Deeper coma, no responses Odour in room (can't defend from bacterial infections) |
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10 minutes |
Gasping, respiration is difficult, face relaxes |
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Cause of Death |
Infarctus, embolie pulmonaire, saignement digestif, choc septique, acidose lactique avec choc, AVC, perte de perfusion cérébrale, hyperkaliémie avec arrêt cardiaque… |
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Agitation protocol |
Anti-psychotic + benzodiazepenes |
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Protocol for respiratory distress |
Opiates for dyspnea Benzodiazepines for anxiety Scopolamine to forget the incident |
