Lorelei Sawchuk, RN, MN, CHPCN(C) Nurse Practitioner & Supervisor Palliative Care Program Royal Alexandra Hospital Edmonton, AB 780-735-4038 [email protected]24 th Annual Palliative Care Conference Edmonton, AB C1, C2…Continuing the Conversation: What is CRITICAL in providing comfort care?
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Lorelei Sawchuk, RN, MN, CHPCN(C)Nurse Practitioner & SupervisorPalliative Care ProgramRoyal Alexandra HospitalEdmonton, [email protected]
24th Annual Palliative Care ConferenceEdmonton, AB
C1, C2…Continuing the Conversation: What is CRITICAL in providing comfort care?
• Utilizing the RMC Goals of Care Designation, the healthcare professional working at a patient’s beside will be able to:– Translate the care needs of palliative patients
designated as C1 or C2 level of care
“What is expected and what do I do when C1 or C2 care is prescribed?”
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Advanced Care Planning & Goals of Care Resources
• Conversations Matter Video Series• Conversations Matter Guidebook• Healthcare Professionals
– Goals of Care Order Form– Advanced Care Planning Tracking Record– Quick Reference Pocket Card
• “By way of example, a person with an M2 designation who develops a new pneumonia would receive treatment aimed at cureof the pneumonia, but only in the current location of care. A person with a C1 designation who develops pneumonia might seek treatment that would relieve potential pain, dyspnea and distress, whether or not the treatment could fully resolve the pneumonia. Sometimes antibiotics would be contemplated for such a patient, with the sole intent of relieving symptoms.”
from heart failure & fluid in the lungs (pulmonary edema)
• Reduce swelling (edema)• Does not help a dry mouth • Does not help thirst if mouth is
well cleaned and moistened
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Hypodermoclysis (HDC) “Clysis”
• IV fluids given through a small needle into the fatty (subcutaneous tissue) just under the skin
• Little worry if accidentally pulled out
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By Mouth
• By spoon• By sponge• By straw• Sips• At risk
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Mouth Care
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Artificial Nutrition
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Management of Agitation
• Restrain (yourself)• Calmness• Chemicals
– Haloperidol– Methotrimeprazine– Midazolam
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Oxygen
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Medication
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Medication Review• Acetaminophen 650 mg po QID• Centrum Forte 1 tab po Daily• Enalapril 10 mg po BID• Folic Acid 5 mg po Daily• Heparin 5000 units SC q12H• Lasix 40 mg po QAM• Metformin 850 mg po BID• Morphine ER (Long acting) 60 mg
po BID• Pantoprazole 40 mg po daily• Peg 3350 packet 17G po QAM• Prednisone 7.5 mg po Daily• Rosuvastatin 10 mg po Daily• Vitamin B6 25 mg po QHS