Nancy Joyner – End Stage Diseases Care When There Is No Cure

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Nancy Joyner – End Stage Diseases Care When There Is No Cure

Disease Prognostication: An Inexact Art & Science

• Death Trajectory and Illness
• Performance scales
• Prognosis tools
• How to determine palliative Care Hospice vs.
• National Consensus Project – Eight Domains for Quality Practice
• Essential Conversations

Heart Failure

• Stages
• Options for treatment
• Devices that extend life
• Symptom Burden/Management
• Prognostic Models
• How can you live better?

Advanced cancer/ Neoplastic Conditions

• Staging Cancer
• Spiritual needs
• Interventions and complications
  • Compression of the spinal cord
  • Superior vena cava syndrome
  • Bowel obstruction
  • Hypercalcemia
  • Fungating wound treatment
  • Signs of imminent death

Pulmonary Disease

• Staging the disease
• Spirometry: A required test
• The MMRC Breathlessness Scale
• Dyspnea treatment: The pain of not-Malignant disease
• The medical toolbox: oxygen, bronchodilators, opioids & steroids

Amyotrophic Lateral Sclerosis

• Diagnostic tests
• Post-polio syndrome: An ALS mimic
• Advance directives and life support decisions: nutrition & gastrostomy, non-Invasive ventilation or invasive?
• Table of useful medicines

Advanced Dementia

• Stages
• Ethical issues: Feeding, medication
• Assuring comfort
• Delirium & dementia
• Interventions for aggression and agitation

Renal Disease

• Dialysis should only be used in the appropriate way
• Staging disease using Glomerular Filtration Rat (GFR).
• Death prediction for hemodynamics
• Symptom burden
• Hospice underutilization

Liver Disease

• Prognostic Determination
• Ethical issues
• Signs of ‘end stage’

Challenging decisions

• What do people want at the End What is the Meaning of Life?
• Respecting the wishes of patients
• Delirium vs near death experience
• Dying Signs, symptoms, and needs – does hydration need to be taken?
• For the mentally ill, there are many things to consider.
• Managing pain as death nears
• Palliative sedation therapy for intractable conditions

Moral Distress

• Ethical dilemmas
• Medication errors
• Conflicted consciences
• Giving the final dose
• Attending the First Death
• Strategies for diminishing death discomfort
• Professional or personal grieving

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Description:

Are you ever looking for creative ways to make sure someone’s legacy will be passed on? Think about Harold, a patient suffering from metastatic bowel carcinoma. He was part of a local “village” It has been transformed over the years from acres of farmland into housing, and eventually a town. To preserve his heritage, he made large posters of his photos and used his carpentry skills in order to build a complete model of the town. When While we visited, his main focus was on teaching us about this legacy. He didn’t want it to be lost with his passing. We began filmtaping the entire story from Harold. He was not yet satisfied. We got his permission to have a local television station come and do a story about the model, the photos, as well as the stories behind them. The TV crew did not mention Harold’s illness or that he was a hospice patient. Harold was thrilled and at peace when the video was broadcast on local TV station. His legacy was passed on soon after his death.

Harold’s story and other case studies will provide examples of amazing opportunities that can be experienced when caring for parents dealing with end stage diseases. End stage care requires exceptional compassion and sensitivity. Healthcare professionals must have a deep understanding of the latest interventions that can improve quality of care for patients with any type of disease process in order to provide holistic, expert care. The unique nature of each end stage disease presents unique challenges to both the patient and their families.

End-stage liver disease is rarely discussed. It is not mentioned in many texts. You may not know that patients who are awaiting a liver transplant can also be receiving hospice care. This is how it works. How can we help patients with COPD that have no other treatment than to visit the emergency department or ICU for their exacerbations? A medical director has a great intervention. It’s time to think out of the box more than we ever have as providers. We’ll be discussing Adele, a patient who was fighting ovarian cancer for 10+ years. She had a 20-item list that had to be completed. “fixed” before she died. She was helped by the team who did a great job. It took only a pencil and a yellow pad of notepaper, as well as dedicated friends. Discover how the team came together to help her fulfill her last wishes. What can we do to keep costs down…yet assist the patient with symptoms experienced? Learn about the most successful strategies in practice. You’ll leave with new tools to apply when a cure isn’t possible but high-quality support and care.