Delirij v paliativni medicini: neprepoznani sopotnik ob koncu življenja

Delirium is defined as an altered state of conscience and alertness. It encompasses a wide variety of symptoms from drowsiness to agitated hallucinations. Delirium is very frequent in terminal stage of cancer and is often overlooked. Misinterpretation of its symptoms and overtreatment may aggravate its severity. The causes are multiple and intertwined. Management of delirium includes non-pharmacological and pharmacological interventions with intent to reorient the patient if feasible, but mostly to prevent further anxiety, stress, and to improve his or her sleep. In some instances sedation of patient is necessary.Delirij je definiran kot spremenjena stopnja zavesti in pozornosti. Vključuje širok razpon simptomov, od čezmerne zaspanosti do agitiranega haluciniranja. Čeprav gre za učinke več dejavnikov na isti sistem (živčevje), bi težko govorili le o enem kliničnem stanju. Delirij se pojavi pri skoraj vseh bolnikih v terminalni fazi in je pogosto spregledan. Napačno razlaganje (zamenjevanje za bolečino) in zdravljenje bolnikovih simptomov ga lahko še poslabšata (predoziranje zdravil). Vzroki so številni in največkrat prepleteni. Diferencialna diagnoza pogosto terja dodaten napor za razločevanje med podobnimi stanji. Zdravljenje vključuje nefarmakološke in farmakološke ukrepe, s kateri želimo bolnika znova orientirati, če je to smiselno, predvsem pa ublažiti prestrašenost in stisko, izboljšati spanje, v skrajnem primeru pa ga uspavati

Care of Patients at the End of Life

Oskrba bolnika ob koncu življenja skuša doseči dva cilja: bolniku omogočiti najboljšo kakovost življenja (umiranja) in poskrbeti za svojce. Za pravilno in pravočasno izvajanje je ključna prava ocena bolnikovega preživetja. Nepaliativni pristop pri oskrbi ob koncu življenja vodi v medicinsko neučinkovito zdravljenje in povečuje bolnikovo trpljenje. Obravnava simptomov je podobna kot v zgodnejših obdobjih paliativne oskrbe. Poseben izziv predstavlja zdravljenje z zdravili. Oskrba se nadaljuje tudi po bolnikovi smrti.Care of patients nearing the end of life is primarily aimed at providing the best possible quality of life to the terminally ill patient and offering support to his family members. To assure appropriate help and to offer it in time, the length of patient’s survival should be assessed. Non-palliative approach to the care of patient nearing the end of life is a path that leads to medical futilityit only increases the patient’s pain and suffering. The treatment of symptoms is similar to that in early stages of palliative care. A special challenge in the care of patients nearing the end of life is the choice of proper drug therapy. The care should be carried on also after the patient’s death by completing the formalities required in the event of death and by giving support to the grieving family members

Oskrba bolnika ob koncu življenja

Care of patients nearing the end of life is primarily aimed at providing the best possible quality of life to the terminally ill patient and offering support to his family members. To assure appropriate help and to offer it in time, the length of patient’s survival should be assessed. Non-palliative approach to the care of patient nearing the end of life is a path that leads to medical futility; it only increases the patient’s pain and suffering. The treatment of symptoms is similar to that in early stages of palliative care. A special challenge in the care of patients nearing the end of life is the choice of proper drug therapy. The care should be carried on also after the patient’s death by completing the formalities required in the event of death and by giving support to the grieving family members.Oskrba bolnika ob koncu življenja skuša doseči dva cilja: bolniku omogočiti najboljšo kakovost življenja (umiranja) in poskrbeti za svojce. Za pravilno in pravočasno izvajanje je ključna prava ocena bolnikovega preživetja. Nepaliativni pristop pri oskrbi ob koncu življenja vodi v medicinsko neučinkovito zdravljenje in povečuje bolnikovo trpljenje. Obravnava simptomov je podobna kot v zgodnejših obdobjih paliativne oskrbe. Poseben izziv predstavlja zdravljenje z zdravili. Oskrba se nadaljuje tudi po bolnikovi smrti

Delirium in Palliative Medicine. An Undisclosed Companion of Life in Times When It Is Reaching Its Term

Delirij je definiran kot spremenjena stopnja zavesti in pozornosti. Vključuje širok razpon simptomov, od čezmerne zaspanosti do agitiranega haluciniranja. Čeprav gre za učinke več dejavnikov na isti sistem (živčevje), bi težko govorili le o enem kliničnem stanju. Delirij se pojavi pri skoraj vseh bolnikih v terminalni fazi in je pogosto spregledan. Napačno razlaganje (zamenjevanje za bolečino) in zdravljenje bolnikovih simptomov ga lahko še poslabšata (predoziranje zdravil). Vzroki so številni in največkrat prepleteni. Diferencialna diagnoza pogosto terja dodaten napor za razločevanje med podobnimi stanji. Zdravljenje vključuje nefarmakološke in farmakološke ukrepe, s kateri želimo bolnika znova orientirati, če je to smiselno, predvsem pa ublažiti prestrašenost in stisko, izboljšati spanje, v skrajnem primeru pa ga uspavati.Delirium is defined as an altered state of conscience and alertness. It encompasses a wide variety of symptoms from drowsiness to agitated hallucinations. Delirium is very frequent in terminal stage of cancer and is often overlooked. Misinterpretation of its symptoms and overtreatment may aggravate its severity. The causes are multiple and intertwined. Management of delirium includes non-pharmacological and pharmacological interventions with intent to reorient the patient if feasible, but mostly to prevent further anxiety, stress, and to improve his or her sleep. In some instances sedation of patient is necessary

Prehrana v paliativni medicini: ko sita vrana lačni ne verjame

The decision to withhold life sustaining measures is always difficult. Countless discussions, suggestions, recommendations by ethical committees offer some support or moral compass in making these decisions; however, in the end, one always finds himself torn between one's own conscience, patient, patient's family and science. The guidelines that apply to critically ill rarely apply to palliative care. Artificial hydration and nutrition primarily attempt to satisfy basic human needs for food and drink. As such they are often regarded as easing suffer rather than sustaining life.Odločitev o izvajanju ali opustitvi postopkov, s katerimi vzdržujemo ali podaljšujemo življenje, je vedno težka. Številne razprave, smernice, priporočila etičnih odborov oz. komisij so do neke mere opora ali moralni kompas, vendar pa zdravnik na koncu vedno ostane razpet med stroko, bolnikom, vestjo in svojci. Priporočila, ki veljajo za kritično bolne, pogosto težko prenesemo v okvir terminalno bolnih. Večinoma vključujejo bolj agresivne ali »herojske« postopke, npr. umetno ventilacijo ali hemodinamsko podporo. S hidracijo in umetno prehrano skušamo zadovoljiti predvsem dve osnovni življenjski potrebi, žejo in lakoto. In v tej luči ju večinoma obravnavamo bolj kot postopka za lajšanje trpljenja, ne pa kot postopka za vzdrževanje življenja

Prehrana v paliativni medicini

The decision to withhold life sustaining measures is always difficult. Countless discussions, suggestions, recommendations by ethical committees offer some support or moral compass in making these decisions; however, in the end, one always finds himself torn between one's own conscience, patient, patient's family and science. The guidelines that apply to critically ill rarely apply to palliative care. Artificial hydration and nutrition primarily attempt to satisfy basic human needs for food and drink. As such they are often regarded as easing suffer rather than sustaining life.Odločitev o izvajanju ali opustitvi postopkov, s katerimi vzdržujemo ali podaljšujemo življenje, je vedno težka. Številne razprave, smernice, priporočila etičnih odborov oz. komisij so do neke mere opora ali moralni kompas, vendar pa zdravnik na koncu vedno ostane razpet med stroko, bolnikom, vestjo in svojci. Priporočila, ki veljajo za kritično bolne, pogosto težko prenesemo v okvir terminalno bolnih. Večinoma vključujejo bolj agresivne ali »herojske« postopke, npr. umetno ventilacijo ali hemodinamsko podporo. S hidracijo in umetno prehrano skušamo zadovoljiti predvsem dve osnovni življenjski potrebi, žejo in lakoto. In v tej luči ju večinoma obravnavamo bolj kot postopka za lajšanje trpljenja, ne pa kot postopka za vzdrževanje življenja

Nutrition during Palliative Care

Odločitev o izvajanju ali opustitvi postopkov, s katerimi vzdržujemo ali podaljšujemo življenje, je vedno težka. Številne razprave, smernice, priporočila etičnih odborov oz. komisij so do neke mere opora ali moralni kompas, vendar pa zdravnik na koncu vedno ostane razpet med stroko, bolnikom, vestjo in svojci. Priporočila, ki veljajo za kritično bolne, pogosto težko prenesemo v okvir terminalno bolnih. Večinoma vključujejo bolj agresivne ali »herojske« postopke, npr. umetno ventilacijo ali hemodinamsko podporo. S hidracijo in umetno prehrano skušamo zadovoljiti predvsem dve osnovni življenjski potrebi, žejo in lakoto. In v tej luči ju večinoma obravnavamo bolj kot postopka za lajšanje trpljenja, ne pa kot postopka za vzdrževanje življenjaThe decision to withhold life sustaining measures is always difficult. Countless discussions, suggestions, recommendations by ethical committees offer some support or moral compass in making these decisionshowever, in the end, one always finds himself torn between one\u27s own conscience, patient, patient\u27s family and science. The guidelines that apply to critically ill rarely apply to palliative care. Artificial hydration and nutrition primarily attempt to satisfy basic human needs for food and drink. As such they are often regarded as easing suffer rather than sustaining life