10: Palliative and Hospice Care Flashcards
1
Q
Automatic or suggested referral to peds palliative care?
Severe progressive scoliosis
A
Suggested
2
Q
Automatic or suggested referral to peds palliative care? Pulmonary atresia (especially if associated with hypoplastic pulmonary arteries)
A
Automatic
3
Q
Hospice falls under what section of government healthcare?
A
Medicare Part A
4
Q
Automatic or suggested referral to peds palliative care?
Severe encephalitis
A
Suggested
5
Q
Automatic or suggested referral to peds palliative care?
Severe mitochrondrial disorder
A
Suggested
6
Q
Automatic or suggested referral to peds palliative care?
Tay Sachs disease
A
Automatic
7
Q
Automatic or suggested referral to peds palliative care?
Down syndrome with significant cardiac abnormality
A
Automatic
8
Q
Automatic or suggested referral to peds palliative care?
Asphyxiating thoracic dystrophy
A
Automatic
9
Q
Automatic or suggested referral to peds palliative care?
Bone marrow/stem-cell transplant
A
Automatic
10
Q
Automatic or suggested referral to peds palliative care?
Progressive neurodegenerative conditions
A
Automatic
11
Q
Automatic or suggested referral to peds palliative care?
Renal failure, not transplant candidate
A
Suggested
12
Q
Automatic or suggested referral to peds palliative care?
Severe immunodeficiency syndromes, particularly those for which BMT is a consideration
A
Suggested
13
Q
Automatic or suggested referral to peds palliative care?
Menke’s disease
A
Automatic
14
Q
Automatic or suggested referral to peds palliative care?
Hunter’s/Hurlerí’s disease
A
Automatic
15
Q
Automatic or suggested referral to peds palliative care?
Immersion injury
A
Suggested
16
Q
Automatic or suggested referral to peds palliative care?
VLBW infants
A
Suggested
17
Q
Automatic or suggested referral to peds palliative care?
Short-gut syndrome with TPN dependence
A
Suggested
18
Q
Automatic or suggested referral to peds palliative care?
Patients with CF with vent dependence or those ineligible for lung transplant
A
Automatic
19
Q
Automatic or suggested referral to peds palliative care?
Family with limited social supports
A
Suggested
20
Q
Automatic or suggested referral to peds palliative care?
Congenital CMV/toxoplasmosis with neurological sequelae
A
Suggested
21
Q
Automatic or suggested referral to peds palliative care?
Persistent vegetative state
A
Automatic
22
Q
Automatic or suggested referral to peds palliative care?
Severe pulmonary hypertension
A
Automatic
23
Q
Automatic or suggested referral to peds palliative care?
Sandoff’s disease
A
Automatic
24
Q
Automatic or suggested referral to peds palliative care?
Sanfilippo syndrome
A
Automatic
25
Automatic or suggested referral to peds palliative care?
| Patients with CF with pain, dyspnea, or other symptoms who would benefit from symptom management
Suggested
26
Automatic or suggested referral to peds palliative care?
| Need for hospice resource utilization
Suggested
27
Automatic or suggested referral to peds palliative care?
| ECMO candidate
Suggested
28
Automatic or suggested referral to peds palliative care?
| New diagnosis of life-limiting/threatening condition
Suggested
29
Automatic or suggested referral to peds palliative care?
| Difficult pain or symptom management
Suggested
30
What level of HF qualifies for hospice?
NYHA Class 4
31
Automatic or suggested referral to peds palliative care?
| Irreversible brain injury that will impact functional status
Suggested
32
T/F A palliative care approach decreases length of hospital stay, including the ICU/CCU, and eases the transition between care settings for patients. This results in increased patient and family satisfaction and compliance with hospital standards (JCAHO). Integrative and consultant services have been used with success.
True
33
Automatic or suggested referral to peds palliative care?
| Krabbe's disease
Automatic
34
Automatic or suggested referral to peds palliative care?
| New diagnosis with complex pain or symptom management issues
Suggested
35
Automatic or suggested referral to peds palliative care?
| Severe birth asphyxia
Automatic
36
Automatic or suggested referral to peds palliative care?
| Long-segment Hirshsprung's
Suggested
37
Stems from the word "hospitality." Beginning in medieval times, monks offered shelter to weary or ill travelers.
Hospice
38
Automatic or suggested referral to peds palliative care?
| Neonatal polycystic kidney disease
Automatic
39
Automatic or suggested referral to peds palliative care?
| Severe metabolic disorders for which BMT is a therapeutic consideration
Suggested
40
Automatic or suggested referral to peds palliative care?
| Severe head injury following NAT
Automatic
41
Automatic or suggested referral to peds palliative care?
| Fabry's disease
Automatic
42
Automatic or suggested referral to peds palliative care?
| Patients with CF with multiple hospitalizations
Suggested
43
Automatic or suggested referral to peds palliative care?
| Three or more hospitalizations within six months
Suggested
44
Automatic or suggested referral to peds palliative care?
| Niemann-Pick disease
Automatic
45
5 cues that could prompt a referral to palliative care.
1. Unacceptable level of pain or other symptom or distress.
2. Uncontrolled psychosocial or spiritual issues.
3. Frequent visits to the emergency department for the same diagnosis.
4. More than one hospitalization for the same diagnosis in the last 30 days.
5. Team/resident/family needs help with complex decision making and determination of goals of care.
46
Automatic or suggested referral to peds palliative care?
| Any newly diagnosed malignant disease with an EFS
Suggested
47
Automatic or suggested referral to peds palliative care?
| MRCP with comorbidities
Suggested
48
Automatic or suggested referral to peds palliative care?
| Eisenmanger's syndrome
Automatic
49
Automatic or suggested referral to peds palliative care?
| Relapsed malignant disease following stem-cell/bone marrow transplant
Automatic
50
Automatic or suggested referral to peds palliative care?
| Cardiomyopathy: hypertrophic or severe dilated
Automatic
51
Automatic or suggested referral to peds palliative care?
| Total aganglionosis of colon
Automatic
52
Automatic or suggested referral to peds palliative care?
| Rett's syndrome
Suggested
53
Aims to relieve suffering and improve quality of life for patients with advanced illness or chronic disease, and their families.
Palliative Care
54
Automatic or suggested referral to peds palliative care?
| Other rare chromosomal anomalies with known poor neurologic prognosis
Suggested
55
Automatic or suggested referral to peds palliative care?
| PICU stay longer than two weeks
Suggested
56
Automatic or suggested referral to peds palliative care?
| Severe feeding intolerance (autonomic enteropathy/chronic intestinal pseudoobstruction)
Suggested
57
Automatic or suggested referral to peds palliative care?
| Prolonged or failed attempt to wean mechanical ventilation
Automatic
58
Automatic or suggested referral to peds palliative care?
| Spinal muscular atrophy
Automatic
59
Automatic or suggested referral to peds palliative care?
| Severe progressive scoliosis
Suggested
60
When did hospice come to the US?
1974. The first hospice in the United States opens: The Connecticut Hospice.
61
Automatic or suggested referral to peds palliative care?
| Static encephalopathy
Suggested
62
Automatic or suggested referral to peds palliative care?
| Progressive metastatic cancer
Automatic
63
Automatic or suggested referral to peds palliative care?
| Severe traumatic brain injury
Automatic
64
Hospice eligibility (3).
1. Two physicians must certify.
2. <6 months to live in normal course of disease.
3. Patient must elect hospice.
65
Automatic or suggested referral to peds palliative care?
| Multiorgan system failure
Automatic
66
Automatic or suggested referral to peds palliative care?
| Combination of cardiac diagnosis with underlying neurologic/chromosomal diagnosis
Automatic
67
Automatic or suggested referral to peds palliative care?
| Bronchiolitis obliterans
Automatic
68
Automatic or suggested referral to peds palliative care?
| Batten disease
Automatic
69
Automatic or suggested referral to peds palliative care?
| Central hypoventilation syndromes
Suggested
70
Automatic or suggested referral to peds palliative care?
| Potter syndrome
Automatic
71
Automatic or suggested referral to peds palliative care?
| Pompe disease
Automatic
72
Automatic or suggested referral to peds palliative care?
| HIV/AIDS resistant to antiretrovirals
Automatic
73
Automatic or suggested referral to peds palliative care?
| Metastatic solid tumors
Suggested
74
Automatic or suggested referral to peds palliative care?
| HIV/AIDS resistant to antiretrovirals
Automatic
75
Automatic or suggested referral to peds palliative care?
| Epidermolysis bullosa
Automatic
76
Automatic or suggested referral to peds palliative care?
| Any relapsed malignant disease
Suggested
77
Automatic or suggested referral to peds palliative care?
| Patients with CF considering lung transplant/at the time of transplant
Automatic
78
Automatic or suggested referral to peds palliative care?
| Patients with CF with FEV1 < 30%
Automatic
79
Automatic or suggested referral to peds palliative care?
| Progressive hepatic or uremic encephalopathy
Automatic
80
How long are hospice benefits under Medicare?
Benefit periods are two 90-day periods, followed by unlimited number of 60-day periods.
81
Automatic or suggested referral to peds palliative care?
| Complex congenital heart disease
Suggested
82
Automatic or suggested referral to peds palliative care?
| Extreme prematurity with concomitant severe BPD, Grade IV IVH, PVL, etc.
Automatic
83
Who helped establish the first US hospice in Connecticut?
Dame Cicely Saunders. She was a nurse, then social worker, then physician.
84
Automatic or suggested referral to peds palliative care?
| Metachromatic leukodystrophy
Automatic
85
Automatic or suggested referral to peds palliative care?
| Trisomy 13, 15, 18
Automatic
86
Automatic or suggested referral to peds palliative care?
| Hydranencephaly
Automatic
87
Automatic or suggested referral to peds palliative care?
| Diffuse intrinsic pontine glioma
Automatic
88
8 components of palliative care.
1. Pain management
2. Symptom management
3. Goals of care
4. Quality of life
5. Family is the unit of care
6. Spiritual/cultural considerations
7. Bereavement
8. Communication is key
89
Automatic or suggested referral to peds palliative care?
| Single ventricle cardiac physiology
Automatic
90
Automatic or suggested referral to peds palliative care?
| Ebstein's anomaly
Automatic
91
Automatic or suggested referral to peds palliative care?
| Ongoing discussion of cardiac transplant
Automatic
92
Automatic or suggested referral to peds palliative care?
| Severe forms of osteogenesis imperfecta (type 3 or 4)
Automatic
93
Automatic or suggested referral to peds palliative care?
| Hypoxic ischemic encephalopathy (moderate to severe)
Automatic
94
Automatic or suggested referral to peds palliative care?
| Biliary atresia
Automatic
95
To ease pain without curing.
Palliative
96
Automatic or suggested referral to peds palliative care?
| Severe anoxic brain injury (not neonatal)
Suggested
97
Automatic or suggested referral to peds palliative care?
| Stage IV neuroblastoma
Automatic
98
Automatic or suggested referral to peds palliative care?
| Anencephaly
Automatic
99
When did the medical board begin offering hospice and palliative care as a specialty?
2006
100
Automatic or suggested referral to peds palliative care?
| Lissencephaly
Automatic
101
Automatic or suggested referral to peds palliative care?
| Muscular dystrophy
Automatic
102
When was the term hospice first utilized in the medical field?
1967. Dr. Cicely Saunders applied the term to specialized care for dying patients at St. Christopher's Hospice in London.
103
Automatic or suggested referral to peds palliative care?
| AND (Allow Natural Death)/DNR order or other ethical conflicts
Suggested
104
Automatic or suggested referral to peds palliative care?
| Severe schizencephaly
Automatic
105
Automatic or suggested referral to peds palliative care?
| Thanatophoric dwarfism
Automatic
106
Automatic or suggested referral to peds palliative care?
| Multivisceral organ transplant under consideration
Automatic
107
Automatic or suggested referral to peds palliative care?
| Patient, family, or physician uncertainty regarding prognosis
Suggested
108
Automatic or suggested referral to peds palliative care?
| Severe myocarditis
Suggested
109
Automatic or suggested referral to peds palliative care?
| Compassionate extubation
Automatic
110
Automatic or suggested referral to peds palliative care?
| Patients who are chronically ventilator-dependent
Suggested
111
What is the goal of palliative care?
The goal of palliative care is achievement of the best possible quality of life for patients and their families.
112
T/F Palliative care helps postpone death.
False. It affirms life and regards death as a normal process. Palliative care neither hastens nor postpones death.
113
Automatic or suggested referral to peds palliative care?
| Complex care coordination and/or home-going needs
Suggested
114
Automatic or suggested referral to peds palliative care?
| Leukodystrophy/ALD
Automatic
115
T/F Hospice and palliative care are synonymous concepts.
False. Palliative care extends the principles of hospice to a broader population that could benefit from this type of care earlier in their illness. Hospice is restricted to those with a certain amount of time left. Palliative care can be appropriate at any point along a disease trajectory. The goal is the relief of distressing symptoms and maximizing quality of life.
116
When did palliative care begin?
1988. The American Academy of Hospice Physicians was formed.
117
Automatic or suggested referral to peds palliative care?
| Feeding tube under consideration for any neurological condition
Suggested
118
Automatic or suggested referral to peds palliative care?
| Prolonged hospitalization for more than three weeks
Suggested
119
Automatic or suggested referral to peds palliative care?
| Conflicts regarding use of medical nutrition/hydration in cognitively impaired, seriously ill, or dying patients.
Automatic
