50 - end of life

Question 1

challenges in EOL

Answer 1

• lack of prior relationship
• limited info on PTs baseline
• little info about PTs wishes
• time constraints

Question 2

how to err in the ER

Answer 2

on the side of intervention if lacking info

Question 3

keys in initial assess

Answer 3

• ID desires
• look up old records
• goals of vist

Question 4

common acute pain causes in palliative

Answer 4

• vert. body fractures
• nerve root
• tumor

Question 5

***how to determine breakthrough dose

Answer 5

24 hour dose / 10 given PO

Question 6

oral to IV conversion

Answer 6

2:1

Question 7

opiod convesion for 10mg morphine

Answer 7

codeine 100
morphine 10
oxy 5
hydromorph 2

Question 8

potential causes for dyspnea

Answer 8

• obst. - upper or bronch
• large pleural effusions
• PE
• pneumo
• CHF/COPD exacerbations

Question 9

how to help dyspnea sensations

Answer 9

• O2
• narco 2.5mg SC
• anxiolytics

Question 10

meds for N/V in pallaitive

Answer 10

bowel/gastric
- DOPA agon
- not much use for gravol
chemo
- 5-HT3 block - odansetron
-

Question 11

how to mgmt constipation

Answer 11

start from bottom
- enema or disimpaction
then above
- lactulose
- Mg citrate
- poly glycol

Question 12

mgmt of delerium

Answer 12

• Tx reversable causes
• halperidol
• maybe benzos

Question 13

mgmt of secretions/death rattle

Answer 13

• scopolamine or glycopyrrolate

Question 14

steps to break bad news

Answer 14

1. 5-10 minutes of quiet
2. sit
3. introduce self and role
4. find out what they know
5. explain in clear simple language what happened
6. leave plenty of silence
7. acknowledge their emotions

Question 15

issues to address after death

Answer 15

1. viewing deceased
2. gather belongings
3. ask who should be contacted
4. ask to notify the funeral home
5. address organ donation
6. if need coroner- tell fam
7. offer medical autopsy if appropriate