Care When There is No Cure for Patients with End Stage Diseases

CPD

Handouts

Faculty

Lores Vlaminck, RN, BSN, MA, CHPN Related seminars and products: 1

Owner

Lores Consulting

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Lores Vlaminck, RN, BSN, MA, CHPN, is a consultant for home care, palliative care, hospice, and assisted living providing education, training, mock surveys, and mentoring for staff development. Lores’ extensive professional nursing experiences span clinical practice in cardiac and intensive care, outpatient clinical services and as a founder/director of a Medicare certified home care/hospice director in greater MN. Her role in the 'trenches' gives her a unique understanding of the challenges and opportunities professionals and volunteers face in accompanying the patient and family facing a serious or life-limiting illness.

Lores offers state and national education on palliative and hospice care and is certified trainer of the ELNEC (End-of-Life Nursing Education Consortium) modules, EPEC (Education on Palliative and End-of-life Care) modules and the HPNA's (Hospice and Palliative Care Nurses Association) curriculum. She is a member of MHCA (Minnesota Home Care Association), MNHPC (Minnesota Network for Hospice and Palliative Care), Leading Age MN, NHPCO (National Hospice and Palliative Care Organization), HPNA (Hospice Palliative Nursing Association-MN Chapter) and Sigma Theta Tau. Additionally, Lores also serves on two not-for-profit long-term care boards.

Through a blend of both grief and joy filled patient stories, clinical expertise and referenced materials, Lores will be sure to engage you at both an intellectual and heart level. Participants across the country have consistently shared that Lores' humility, honesty, humor and genuine compassion allow for permission to "feel what is felt."

Speaker Disclosures:

Financial: Lores Vlaminck is Principal for Lores Consulting. She receives a speaking honorarium from PESI, Inc.

Non-financial: Lores Vlaminck has no relevant non-financial relationship to disclose.

Additional Info

Program Information

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Objectives

1. Summarize the assessment scales that are predictive of poor survival.
2. Explain the importance of prognosis and shared decision-making.
3. Evaluate the benefits of using palliative care principles for patients with end stage disease.
4. Distinguish palliative services vs. hospice services.
5. Choose strategies to help patients overcome the fear of death.
6. Predict challenging end of life symptoms and the best interventions.

Outline

Disease Prognostication: An Inexact Art & Science

• Individualized care: The importance of prognosis (science/art/intuition)
• Determining palliative care vs. hospice care
• Crucial conversations
• The hospice benefit

Congestive Heart Failure: The Broken Heart

• Best practice: The Seattle HF Model
• Medication management strategies
• Symptom management and pain management
• Pacemakers, ICDs & LVADs - Living better or prolonging suffering?

Chronic Obstructive Lung Disease

• Global Obstructive Lung Disease (GOLD) Guidelines
• The COPD Assessment Test (CAT)
• Treating dyspnea: "The Pain of Non-Malignant Disease"
• The medication tool box: Oxygen, bronchodilators, opioids and steroids

Renal Disease

• Appropriate use of dialysis
• Staging disease with Glomerular Filtration Rate
• Hemodialysis mortality predictor
• Symptom burden
• Underutilization of hospice
• Opiods with dialysis

Liver Disease

• Indicators of poor prognosis
• Differentiating when cirrhosis is the cause
• Most useful analgesics for the pain
• Waiting for transplant while on hospice: Use of the MELD tool

Advanced Dementia

• GDS: FAST
• Pain scales
• Feeding tube dilemmas - and outcomes
• Delirium and dementia: Interventions for agitation and aggression
• End state dementia

Amyotrophic Lateral Sclerosis

• Diagnostic tests for ALS
• Advance directives and life support decisions
• Nutrition and gastrostomy
• Non–invasive ventilation
• Table of useful medications and palliative measures

Advanced Cancer

• The value of early palliative care
• Spiritual needs
• Complications and interventions
  • Spinal cord compression
  • Superior vena cava syndrome
  • Bowel obstruction
  • Hypercalcemia
  • Fungating wound/terminal Kennedy ulcer

Eight Signs of Impending Death

Challenging Decisions

• What do people want at the end of life?
• Delirium vs. near death awareness
• Mental health needs of the dying
• Palliative sedation therapy for intractable symptoms
• Does the dying person need hydration? Oxygen? Treatment for rales?

Moral Distress

• Uncomfortable patient/family scenarios
• Ethical dilemmas
• Medication errors
• Conflicted consciences

Target Audience

• Nurses
• Nurse Practitioners
• Clinical Nurse Specialists
• Social Workers
• Counselors
• Case Managers
• Chaplains
• Clergy

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