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Comprehensive Care and anatomy CCAA colleges CAT 1
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College aantekeningen minor CCAA van CAT 1
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WEEK 1Hepato …
Bilirubine waarde bij >50 umol/L
icterus?
ASAT:ALAT ratio <1 acute lever of chronische leverziekte zonder fibrose
> 1:0 cirrose, alcohol, Wilson’s disease
> 2:1 suggestive
> 3:1 highly suggestive for alcoholic disease
Galstenen oorzaak? Vaak door verhoogde cholesterol waarden
Upper GE 1
Binnenbekleding GE Maag heeft plooien
Slokdarm is glad
Wat kan je met een Kleur op tumormarkers
biopt?
Hoe kom je achter de Stageringsonderzoek doen → TNM stadium
prognose? - T → MDL arts of goed gesprek voor nodig
- passageklachten heeft vaak al T2-3 stadium
- N → PET-CT om klieren te onderzoeken
- PET-CT want dan kan je preciezer beeld krijgen, bij een
normale CT scan dan zie je ook alle fysiologische
processen FDG in het lichaam.
- M
- …
Geen metastase maar N-stadium → loco-regionale en die bepalen niet curatief of palliatief
wel oplichtende M-stadium → ..
lymfeklieren, wat
T3 N1 M0, wat is de kans 30%
dat hij er over 5 jaar nog Voorbehandeld met cross
is? En samenvatting van PET-Ct gekeken naar lymfe en metastasen
patiënt. Ivor Lewis
Na 7 dagen zonder lekkage naar huis gegaan
YP → betekent Y voorbehandeling en P voor totaal pathologisch beeld
Behandeling 5 weken elke dag
Upper GE 3
Intestinale metaplasie Verandering van wand slokdarm
Kolieken van holle Darm-, nier- en galsteen
organen
Galstenen substantie 80% cholesterol (yellow/green)
20% pigment (brown=calcium, black=bilirubine)
Cross-schema 5 weken lang elke dag bestraling en 1/week chemotherapie
, - Enorme impact op de patiënt
Prone position Rugligging voor epidurale verdoving
WEEK 2
Advanced Care Planning (ACP)
Palliative care Zorg waarbij kwaliteit van leven en sterven voorop staan en waarin
voor- en nadelen in het licht daarvan tegen elkaar worden afgewogen.
Wat is advance care Define goals and preferences for the future medical treatment and care,
planning? to discuss these goals with family and health-care providers, and to
record and review these preferences.
- Vroegtijdige zorgplanning
Verschil advance directive AD is meer documenteren en patiënt op papier laten schrijven en ACP
(AD) en advance care ga je in gesprek met patiënt.
planning (ACP)?
Verschil ACP en Shared SCOPE
Decision Making (SDM)? TIMING
Wat is overeenkomst ACP en Exchange of information
SDM? Values are important
Wat is SCOPE? Treatment decision here and now vs a range of treatment and care
options for a range of potential situations.
Waarom is ACP belangrijk? - More conversations
- More advance directives
- More accordance between preferred and provided care
Welke eigenschappen zijn Luisteren
belangrijk bij ACP? Weten
Verbinden
Alertheid
‘End of life’ communicatie - Open
- Confident
- Social
- Rational
- Proactive
Structuur ACP gesprek - Introductie
, - Conversation starter
- What is important for you in the future?
- Tell me about your illness how things have been going
for you in the past few months?
- Listen, ask, give information
- Would you like to be 100 years old?
- Can you telle me something about your reason for doing
euthanasia advance directive?
- Have you ever had an experience with healthcare, that
made an impression on you?
- Resume
- From ACP to AD
- Instructions
- Close
Wat is multimodale Verschillende disciplines met verschillende aanpakken door het hele
treatment? behandeltraject, dus van diagnose tot uiteindelijke follow-up.
Who should engage/perform - GP or specialist in a hospital
ACP? - Nurses, nursing assistants, practicing nurses
- Working agreements and transfer of information
Pro’s and Con’s of treatment
Introduction clinical visits
Wat zijn de groepen
binnen palliatieve
zorg?
Palliative approach - Patiënt prioriteiten
- Proactief denken over problemen
- Weet wanneer de besluit momenten zijn
- Shared decision making
- Report on policy and agreements
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