18 Palliative Care

Question 1

Can families stay involved with onc team once involved with hospice?

Answer 1

Yes, make sure the family knows that we are still involved. They can be worried about losing touch with onc team

Question 2

How to handle giving fluids/nutrition while on hospice?

Answer 2

If child does not desire them or gain benefit, its important to educate the family that during the natural process, the body reaches a point where it does not process fluids or nutrition. This is often a concern for families

Question 3

Whether or not to do lab tests in hospice?

Answer 3

consider childs discomfort level and the intervention based on the results, and whether it aligns with the parents’ wishes. some families really need to see the disease progress and it is difficult to stop blood work when they are so used to it. Only withdraw measures in collaboration with the family.

Question 4

How to help families recognize pain in hospice patients

Answer 4

watch for facial cues like irritability, grimacing, rigidity, lack of movement, moaning, etc

Question 5

What route for pain meds?

Answer 5

least invasive possible. try to avoid injections.

Question 6

What is the principle of double effect

Answer 6

the balance between desirable effect and undesirable effect (resp depression and pain meds)

Question 7

How to help treat dyspnea

Answer 7

O2 to improve comfort (not blood gases), opioids, positioning, fans relaxation and distraction

Question 8

When in spiritual distress or anxiety, what to do first?

Answer 8

assess

Question 9

What is FICA

Answer 9

part of spiritual assessment:

FICA: Faith, Import or Influence, Community, Address

Question 10

What is SPIRIT

Answer 10

part of spiritual assessment
SPIRIT: Spiritual belief system, Personal spirituality, Integration with a spiritual community, Ritualized practices and restrictions, Implications for medical care, Terminal events planning

Question 11

What is HOPE

Answer 11

part of spiritual assessment:
HOPE: Sources of Hope, Organized religion, Personal spirituality or spiritual practices, Effects on medical care and EOL issues

Question 12

How can you help parents support patient?

Answer 12

Give them concrete activities. Focus on all senses for comfort, ex:
Caressing
Subtle lighting
Pictures /Movies
Music /Reading out loud 
Potpourri/Scented candles 
Sweet liquids in small amounts

Question 13

What is a goal of pain meds r/t movement

Answer 13

pain should be controlled with movement