8. End of Life Flashcards
Definition of palliative medicine
patients whose disease is not responsive to curative treatment. Management of pain, other symptoms- focus of care is on immediate quality of life
-Focused on comfort, relief and immediate function
What are the 5 Kubhler-Ross Stages
Stages people go through when they find out they are dying
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
T/F The 5 stages of Kubhler-Ross also present in order
F- some steps are even skipped
Why is a sympathetic touch from the doctor significant to patients
leaves people with impression that the visit lasted twice as long
How should you address a patient’s companion
You should always address the patient unless they can’t understand
What oral issue has the greatest prevalence in terminally ill patients? Other oral issues are…
Candidiasis= 1
- Xerostomia
- Denture issues
- Oral soreness
Goals of dental management for terminally ill patients
- Monitor and treat oral disease
- Manage xerostomia
- Evaluate oral hygiene
- Adress oral pain
- Maintain OHI and function
- Maintain overall quality of life
Terminal cancer patients with Head and Neck cancers typically have what oral problems
- Pain
- Feeding issues
- Compromised airway
- Dysphagia
- Xerostomia
- Candida
- Mucositis
- Oral ulcers
- Altered taste
- Poor OH
- Rampant caries
Primary complications from H&N cancer like xerostomia and poor OH (Pain) can lead to what secondary complications
- Dehydration
- Dysguesia (altered taste)
- Source of systemic infection
Radiation of the head and neck can irreversibly injure what tissuses… which can lead to…
- Oral mucosa
- Vasculature
- Muscle
- Bone
Which can lead to… xerostomia, rampant caries, trismus, soft tissue necrosis and osteonecrosis
Acute complications of radiation therapy are
- Oral mucositis
- Infection (bacterial and fungal)
- Salivary gland dysfunction (sialadentis and xerostomia)
- Taste dysfunction
Difference between radiation and chemo
- Radiation damage is site specific
- Chemo travels in blood and affects many sites
The degree of damage by radiation is dependent on
- Type of radiation used
- Total dose administered
- Field/size fractionation
Loss of funciton of salivary glands as a result of radiation is dependent on
- Total dose
- Time
- Gland dependent
Which salivary gland cells are more sensitive to radiation damage (Mucous/serous)
serous
What salivary gland is most sensitive to radiation
parotid
Salivary dysfunction as a result of radiation damage may persist for how long
indefinitely
When during radiation treatment does oral mucositis most commonly occur
During 2nd week of radiation
When during radiation therapy does oral mucositis typically resolve
2-3 weeks after therapy is complete
Describe the 5 different phases of oral mucositis formation as a result of radiation
Phase I= initiation –> Chemo
Phase III= Messaging, signaling and amplification –> Blood vessels
Phase IV= Ulceration (mucus lids) –> inflammatory cell
Phase V= Healing –> Fibroblast
Oral mucositis lesions put the patient at a greater risk of _ and may compromise _
systemic infection… airway
Is oral mucositis painful
yes- so much so that sometimes the patient can’t eat
What are the different agents that can be used to manage mucositis
- Bland rinses
- Topical anesthetics
- Mucosal coating agents
- Analgesics
Describe bland rinses for mucositis management
- 0.9% saline solution
- Sodium bicarb solution
- ).9% saline/sodium bicarb solution
Describe the topical LA that can be used to manage . mucositis
- Lidocaine (Viscous, ointment, spray)
- Benzocaine (Spray and gel)
- 0.5% or 1.0% dyclonine hydrochloride (HCl)
- Diphenhydramine
What are the different mucosal coating agents for managing mucositis
- Amphojel
- Kaopectate
- Hydroxypropyl methylcellulose film forming agents (Zilactin)
- Cyanoacrylate mucoadherent film
- **Gelclair (FDA approaved) Sooths pain by sheilding exposed and overstimulated nerve endings
Analgesics for mucositis management
- Benzydamine HSL topical rinse (not approved in US)
- Opioids
Anti-viral drug regimen for HSV, Varicella zoster, EBV, and CMV
Acyclovir 200 mg
- Disp: 25
- 5 per day evenly spaced for 5 days
_% of patients report xerostomia after chemo/radiation
40
Symptoms of xerostomia
- Dry
- Burning
- Fissuring at lip commisures
- Atrophy of dorsal tongue
What are the two categories of saliva stimulants
- Proprioceptive stimulators (i.e gum, acids, etc)
- Parasympathetic agents
Drugs that increase salivation
- Pilocarpine
- Cevimeline
- Bethanacol
- 2% citric acid
