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2557

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8-11 10-29 80,780 29.2

2

20 2557

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3/71

1 1

2

2 3

1 4 2 8

3

12 4 14 5 16 6 18 7 20

8 21 24

1 26 2 27 3 18 4 32 5 32

Risk Fall Assess Form

Bradens Score Q 9Q

8Q MMSE

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Edmonton Symptom Assessment Scale (ESAS) Log

()

1 62 30

25 29

30

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1

468.3 2548 759.8 2555 8 12.6 2510 43.8 2540 98.5 2555 25.3 2548 31.7 2555 0.8 2547 1.6 2553 10 (2542 - 2552) 11

(102,330 113,548 ) ( ,2555; Cancer control, knowledgeinto action World Health Organization,2007)

8-11 10-29 ( ,2553) (Hospice)

(Caregiver) (Hospice)

(Palliativecare) WHO

()

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2

(Bereavement Care) (European Association for Palliative Care, WHO)

(Quality of Life care Unit) 8

1 2 3 4 5 6 7 8

5 1 2 3 4 5

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3

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4

1

(Staff)

1. /2. 3. 4.5. 6. /7. /8.

1. 2. (Communication skills)

(Nurse)1. ()2.

(Communication skills)3. 2 4.

3 5. 3 6.

4

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5

1. morphine 2.

1. 2. ()

1.

2.

3. 4.

1. 2.

3.

/

1.

2. 3. 4.

5.

6.

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6

1

1. 2. 3. 4.

5.

6. 7.

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7

/1. ()2. 3.

4. (Walker)5. 6. 7.

1.

/ 2. 3.

4. (

Healing environment)5.

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8

2

(Pain)

(1) (non invasive) (by mouth) (by the clock)

codeine tramadol (around the clock) (breakthrough pain)

1

(by the ladder)

1 non opioids2 weak opioids non opioids3 strong opiods non opioids

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9

3 1. :

1.1

(Body chart)

1.2 1.3 1.4 1.5 1.6

2.

2.1 2.2 Palliative radiotherapy

2.3 (massage) (acupressure) (acupuncture) (heat) (cold) (TranscutaneousElectrical NerveStimulation:TENS) ( touch) (therapeutic touch)

3. (1 )

(Dyspnea)

1. : (Visual Analogue Scale :VAS)

2. :

(hematocrit) (hemoglobin) Pericardial effusion, Pleural effusion, Superior vena cavasyndrome, Pneumonia

3. :

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10

3.1 Opioids, Benzodiazepines, Phenothiazines, Beta2-Agonist stimulators , Methylxanthines , Steroid , Oxygen therapy Dyspnoea in Palliative Care www.patient.co.uk

3.2 (pursed-lip) diaphragmatic

(Fatigue)

1.

:

2. :

3. : Steroid Erythopoctive Anti-depressive

(Constipation) Opioid

Surfactant Docusate Osmotic Lactulose,magnesium hydroxide Lubricant Mineral oil Stimulants Bisacodyl, senna

(Nausea and Vomiting)

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11

:-domperidone, prochlorperazine , metoclopramide ,

ondamsetron, granisetron , haloperidol

(Skin and pressure sore)

(BardenScore) 2

/ /

(Complementary and alternative medicine) / , (massage therapy), (acupuncture),(Aroma therapy) , (Music therapy) , ( Humor therapy) , ( imagery) , (distraction) , (Yoga) , (Pet-therapy) , , (Hydro therapy), (prayer) , (Hypnotictherapy) , (Biofeedback) , (Relaxingtraining) , (Self help group) , (Educative and Supportive) ,(Art therapy), (Thai-traditional medicine),( Herbal medicine)

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12

3

(Psychological)1. (

/ (Spiritual)

2. 2Q , 9Q 8Q () (cognition) MMSE-T ()

3. : Five stage reaction Kubler-Ross (1969)

1.(Shock & Denial)

2. (Anger)

3.(Bargaining)

/

4.(Depression)

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13

5.

(Acceptance)

1 5

5 ( , , ,2551)

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14

4

(Social assessment) 1. :

2. :

3. :

4. :

5. : (Family / Relatives)

(Friends) (Work / School Associates) (ProfessionalCaregivers) (Neighbors)

6. :

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15

1.

2. 3.

4.

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16

5

( ) ( , 2555)

1. EQ 2. 3.

1.

2. 1 (spiritual screening)

3.

4. (2004)///

5.

5.1 -

5.2 24

5.3 Family meeting/

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17

5.4

(Narayanasamy, 2004)

- - --

- -- - -

-

-

- - -

- -

--/

--

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18

6

1. 1.1 ( ) ( ) ( ) 1.2

1.3 (

)1.4 1.5

( ) ( )

( ) ( )( ) ( ) ( ) ( )( ).

1.2.

3.

( )

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19

()

4. ()

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20

7

2 7

1. :

2. :

3. :

4. : 5. :

6. :

7. :

( )

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21

8

1. (Biomedical ethics) : 4

1.1(Beneficence)1.2 (Nonmaleficence)1.3 (Autonomy)1.4 (Justice)

2. (Patients Bill of right) : - ( 10 )

3. (Informed Consent) :

3.1 3.2 3.3 ()

- :

- - ( Informed

Consent) ()

4. (Advance Directives):

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22

---- Delirium , Dementia , Coma -

Advance directives

4.1 Living will:

...2550 12

Living will pain medication

4.2 Durable power of attorney (DPA) for health care :

4.3 Conversation :

Advance Directives

4.4 Written directives :

()

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23

4

) )

) )

(mercy killing)

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24

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25

(The Association for Childrens Palliative Care and British Royal College ofPediatricians and Child Health)

.

.

.

.

() (concept)

concept

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26

-

() (concept)

- magical thinking

-

(causality) (irreversibility) (finality) (universality)

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27

3

Counseling

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28

End of Life (no CPR, oxygen)

End of Life

dyspnea, , no CPR

privacy

autopsy tissue donation

Bereavement Care

(pain assessment) (pain management)

(qualitative assessment)

(quantitative assessment)

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29

(pain intensity)

(Composite pain

measures)

(Behavioral

measures)

(Self-report)

PIPP CHEOPS VAS

NIPS FLACC Wong-Baker Faces Scale

CRIES OPS FPS-R

NRS

PIPP = Premature Infant Pain Profile, NIPS = Neonatal Infant Pain Profile, CHEOPS =

Childrens Hospital of Eastern Ontario Pain Scale, FLACC = Face Legs Activity Cry

Consolability, VAS = Visual Analog Scale, FPS-R = Faces Pain Scale-Revised, NRS = Numeric

Rating Scale, OPS = Objective Pain Scale

self-report(gold standard)

(pain diary)

()

.

/ /

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30

(pharmacological management) (non-pharmacological management)

.

.

2

Non - opioids Acetylsalicylic acid (ASA),

Paracetamol, Ibuprofen,

Indomethacin, Naproxen, Diclofenac

Opioids

Codeine, Tramadol

Opioids Morphine, Methadone,Hydromorphone, Pethidine,

Buprenorphine,Fentanyl (transdermal)

Opioid antagonist Naloxone

Antidepressants Amitryptyline, Imipramine

Anticonvulsants Carbamarzepine, Valproic acid

Corticosteroids Prednisolone, Dexamethasone

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31

. prn(rescue dose) breakthrough pain 4

. )(

4.

pethidine toxic metabolite

1. opioid

2.

3. opioid - withdrawalsymptom %

.

Supportive therapy: family centered care,

Cognitive therapy: distraction, imagery, hypnosis, music

Behavioral therapy:

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32

Physical therapy: / aromatherapy, transcutaneous electrical nerve stimulation (TENS)

4

5

palliative care

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33

1.

2.

3.

4.

5.

6.

7.

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Spiritual support

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... .....

Last wish

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Last wish

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Last birthday

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Home care

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Healing Environment

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Complementary and Alternative medicine

5/19/2018 2557

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Volunteer

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1.

. 2555.. , .2. . 2556. . .

3. . 2556. Palliative care. 1. ,.

4. .. 2550..2., .

5. , , . 2551.

.

,

.

6. . . :; 2547.

7. . . : , , , . . : ; 2552. 239-257.

8.. 2551..

9.

. 2556..1., .

10.. 2552..

11.. 2552..

12.. 2556.. 1 1. .,.

13.

American Academy of Pediatrics, Committee on Bioethics 1999-2000. Guidelines

on forgoing life-sustaining medical treatment. Pediatrics. 2000; 106(2): 3517.14.American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and

Family Health. The pediatrician and childhood bereavement. Pediatrics 2000;

105: 445-7.

15.Brown MR, Sourkes B. Pediatric palliative care. In: Shaw RJ, Demaso DR editors.

Textbook of pediatric psychosomatic medicine. Arlington: American psychiatric

publishing; 2010. 245-57.

16.

Complementary,Alternative, or Integrative Health: Whats In a Name?

Available6/3/2014 from:http://www.nccam.nih.gov

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17.Cunningham T. MCCN Psychosocial assessment guidelines version 2: March 2010.

1-5.

18.Goldman A, Frager G, Pomietto M. Pain and palliative care. In: Schechter N, Berde

CB, Yaster M, ed. Pain in Infants, children, and adolescents 2nd

ed. Philadelphia:

Lippincott Williams&Wilkins; 2003: 539 562.

19.Grgoire M, Frager G. Ensuring pain relief for children at the end of life. Pain Res

Manage 2006; 11 (3): 163 171.

20.Himelstein BP, Hilden JM, Boldt AM, Weissman D. Pediatric Palliative Care. N Engl J

Med 2004; 350: 1752-62.

21.Hution N, Levetown M, Frager G. The hospice and palliative medicine approach to

caring for pediatric patients. Glenview: American academy of hospice and palliative

medicine, 2008.22.Kuber-Ross E. On death and dying. New York: Scribner; 1969.

23.Lewis M, Schonfeld D. Dying and Death in Childhood and Adolescence. In: Lewis

M, ed. Child and Adolescent Psychiatry. Philadelphia: Lippincott Williams & Wilkins;

2002: 1239-45.

24.Narayanasamy A. The puzzle of spirituality for nursing. A guide to practical

assessment. Br J Nurs. 2004; 13(19): 1140-1144.

25.Vachon ML, Kristjanson L, Higginson I. Psychosocial process and issues in palliative

care: the patient, the family, and the outcome of care. J Pain Symptom Manage.

1995; 10(2): 142-50.

26.World Health Organization. Cancer pain relieve and palliative care in children.

Geneva: World Health Organization, 1998.

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( Palliative Performance Scale version 2 ) (PPS v2)

PPS v2

100%

90%

80%

70%

60%

/

50% /

40%

+/-

30%

+/-

20%

+/-

10%

()

+/-

0% - - - -

+/-

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()

1.

2.

3.

4.

5.

6.

7.

8.//

9.

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Edmonton Symptom Assessment Scale (ESAS)Log

-.. ..

HN.DX.

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Prn 1

2.. 2

3.. 3

scale

10

9

8

7

6

5

4

3

2

1

0

Pain Prn

sedation score

respirations

signature

site

characterize

time

s=

sedation score =2+RR10/min

sedation 0=

3=

..................................................................... HNDXMetastasis....

......................

1= 2=

.....................

....................

(cont.)

pain 1.....................................................................

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(Risk Fall Assess Form)

Name............................................................................... Age........................HNWARD

Risk Factor ScaleScore Patient score

Morse Fall Risk Score Date.. Date.. Date.. Date.. Date.. Date..

History of FallYes 25

No 0

Secondary Diagnosis

Yes 15

No 0

Ambulatory Aid

Furniture 30

Crutches/Cane/Walker 15

None/ Bed rest/ Wheel chair/ Nurse 0

IV/Injection plug Yes 20

No 0

Gait / Transferring Impaired 20

Weak 10

Normal / Bed rest / Immobile 0

Mental Status Forgets / Limitations 15

Oriented to Own Ability 0

Morse Fall Score Date. Date. Date. Date. Date. Date.

45

25 44

0 - 24

Morse Fall Risk

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Bradens Score

Name. Age HN..Ward

Score ........................ ............

4 3 2

1

4 3 2

1

4/ 3/ 2 1

4Feed /> 3Feed / 2NPO/

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2Q

NameAgeHN..Ward...............

( )

1. 2

2. 2

2

2

9Q

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9Q


( )

2

(7 )

1.

2.

3.

4. 5.

6.

7.

8.

9.

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- 7-12

- 13-18

- >19

: > 7 8Q

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8Q


( )

1. 1

2. 1

3. 1

(..)

4.1

5. 1

6. 1

7. 1

8.

- 1-8

- 9-16

- >17

Admit

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MMSE Thai 2002*Mini Mental State Examination : Thai version (MMSE Thai 2002)

1. Orientation for time ( 5 ) (1 ) ()1.1 ..1.2 ..1.3 ..1.4 ..1.5 ..2. Orientation for place ( 5 ) ()(1 2.1 2.1.1 ...... ..2.1.2 ..2.1.3 - ..2.1.4 ..2.1.5 ..2.2 2.2.1 ..2.2.2 /// ..

2.2.3 / ..2.2.4 ..2.2.5 ..3. Registration ( 3 )

3 (, ....) () (,....)

3 * ( 1 1 )

..*2 ..

4. Attention/Calculation ( 5 ) ()(,....) ?4.1 4.2

4.1 100 7 () 51,2,3 4.2

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4.2 () (, ....) (, ....) ----

(,....)

5. Recall ( 3 )

3 ( 1 1 ) ..

2 ..

6. Naming ( 2 )6.1

..6.2

..7. Repetition (1 )

(1 )() () (,)()

..8. Verbal command ( 3 )

()(, ....)............(,,)-4

(,,) ..9. Written command (1 )

(, ....) (, ....) ...

10. Writing (1 )(, ....) 1 ...............................

..11. Visuoconstruction (1 )

() ..

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-(-) < 14 23(4,9,10)- < 17 30- < 22 30

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..............................................................

(-)...

...

..

..

.

.

( 1 )

...(I.C.U )

......................................................................................................................... ....................................

................................................................................................. ............................................................

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( )

( - ) .... ()

................................................................................................................................................................................................................................................................................

(

)

-..................................................................................................................................................................................................................................................................................................................................................................... -....................................................................................................................................................................................................................................................................................................

-.........................................................................................................................................................................................

................................................................................................................................................

-..................................................................................................................................................................................................................

................................................................................................ ..................................................

( )

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-....

.

HN..

//..............................................

/

(2)

(1)

0

1.

2.3. 4..

5.Morphine

.......................................................................................................................................... ....................................

.................................................................................................. ............................................................................

............................................................................................................................. .................................................

.................................................................................................. ............................................................................

............................................................................................................................. .................................................

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- ................................................................................ HN ..

Admit /................................................ ....................................................

-........................................................... .................................................... .....................

............................................................ ................................................................

/

...............................................

...................................................

(2)

(1)

(0)

(2)

(1)

(0)

1. ( )2. 3. Retained

foleys cath. / on urostomy

On Colostomy4. ...........................

5. / 6. 7. ....................................................8.

9. 10. 11. Duragesic

12. 13. /

/

/

/

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1

(Pain assessment form for Palliative Care)

-...................................................................... ................ Palliative care case No. ....................................

HN. AN ward

..................................................................................................................

Brief Hx, Physical exam and investigation

Diagnosis

Pain assessment

Location

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2

Quality (characteristics, onset, duration etc.)...........................................

Nociceptive somatic visceral Neuropathic

Pain score: present........ pain at rest ..... worst pain...acceptable pain ..

Aggravating factor .

Relieving factor ..

Other symptoms .

Previous treatment

.

..

..

Plan

..

............................................... ..........................................

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(palliative care case file)

............................................................ .......................... ................... .............

HN ............................................

(primary diagnosis)

(date of diagnosis) .................................................

-............................................................... ...........

..............

........................................................................................................................................................

...............................................................................................................................................................................

................................................. ..................................................................

Case coordinator 1.

2.

/

Pain team

Spiritual team

PalliativecarecaseNo._____/__

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2

Admission

Admission date Discharge date summary

Result

Cure expire

PalliativecarecaseNo._____/__

Documents

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