Chronically Ill, The Dying And Hospice Care Flashcards by Carol Genesis

Which of the following is not a GOOD way to communicate with older patients:
A. Be aware of sensory deficits
B. Speak slowly and loudly
C. Seat nearer to the person
D. One question at a time
D. Repeat rather than rephrase

Reason: Rephrase than repeat

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History taking: instrumental activities of daily living EXCEPT:
A. Service
B. Housekeeping
C. Accounting
D. Food preparation
E. Transportation

A. Reason: SHOPPING

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Effects of aging on auditory system EXCEPT:
A. Closure of superior orbital fissure
B. Decline of sound frequency discrimination
C. Decline of localization of high frequency sounds
D. Vascular occlusion of the inner ear
E. Decline of the auditory threshold

Reason: CN VIII- vestibulocochlear nerve: internal meatus canal

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Difficulty in communication with the older person may be due to EXCEPT:
A. Reduced reaction time
B. Schizophrenia
C. Impaired vision
D. Hidden psychosocial issues
E. None of the above

E. None of the above

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AGE-related hearing loss which is permanent and located in the inner ear.
A. Hyperacusis
B. Tinnitus
C. Presbycussis
D. Misophonia

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Hearing performance of the older patient on peripheral pathology:
A. Hearing loss for speech
B. Hearing problem with difficult in speech
C. Problems in binaural listening
D. Hearing loss for pure tone

A and D

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Persistent ringing or buzzing noise in the ears
A. Tinnitus
B. Hyperacusis
C. Misophonia
D. Presbycussis

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History taking: activities of daily living must be noted EXCEPT:
A. Dressing
B. Eating
C. Aspiration
D. Toileting
E. Hygiene

Reason: Ambulating

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Causes of hyponatremia:
A. Defective Calcium conservation
B. Diabetes insipidus
C. Decreases in glomerular filtration rate
D. Glycosuria

C
Reason: A. Defective in SODIUM conservation; B and D are both causes for Hypernatremia (DI - excessive thirst and excretion of large amounts of severely diluted urine) (Glycosuria - excretion of glucose on the urine)

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True or False. Hospice focuses on the length of life of an individual.

False. It focuses on the QUALITY of life

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VISUAL changes in aging EXCEPT:
A. Proliferation of new cells at the periphery of the eyes
B. Maturation of lens fibers
C. Macular degeneration
D. Capsule becomes more thicker and permeable
E. Decrease in pupil size

Reason: Capsule should become LESS thicker and LESS permeable

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It increases the risk of fracture in elderly patients because it cause subtle neurologic impairment that affects gait and attention
A. Hypernatremia
B. Mild hyponatremia
C. Diabetes
D. Arthritis

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Aging is accompanied by an increased sensitivity to EXCEPT:
A. Background noise
B. Touch
C. Recruitment
D. Loudness

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A concept of care whose goal is to maximize the quality of a patient’s life when the quantity of that life can no longer be increased
A. Palliative care
B. Hospice care
C. Elderly care

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In assessing depression on geriatrics, what scale is used?
A. Hamilton depression rating scale
B. GDS
C. Montgomery-Asberg depression rating scale
D. Raskin depression scale

B. Geriatrics Depression Scale

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Continues to obtain treatment while denying the prognosis
A. Anger
B. Depression
C. Shock and denial
D. Bargaining

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Instrument used for cognitive testing
A. ADL
B. MMSE
C. MNA

B. Mini-mental state examination

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Stages of Death and Dying:
A. Shock and denial, anger, depression, negotiation, acceptance
B. Shock and denial, anger, negotiation, depression, acceptance
C. Shock and denial, depression, anger, negotiation, acceptance

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Hospice team members EXCEPT
A. Speech, physical and occupational therapists
B. Counselors
C. Home health aids
D. Local workers
E. All of the above

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Goal of palliative care is to enhance quality of life through \_\_\_\_\_\_\_\_\_\_\_\_\_ symptom management.
A. Psychological
B. Social
C. Spiritual
D. Assiduous

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Patients who have terminal illness
A. Palliative care
B. Hospice care
C. Curative care

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Patients desire for control in a situation
A. Negotiation
B. Shock and denial
C. Depression
D. Anger

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Mission of HOSPICE TEAM except
A. Provides bereavement care
B. Teaches the family how to provide care
C. Attends emotional, psychosocial and spiritual aspects
D. Manages personal life of the patient
E. All of the above

D. It only manages pain and symptoms

"MAD-PAT" acronym for HOSPICE TEAM mission
Manage
Attends
Develops
Provide
Advocates
Teaches

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Area of healthcare thar focuses on relieving and preventing the suffering of patients
A. Palliative care
B. Hospice care
C. Elderly care

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Prognosis of illness is up to ___ or less if disease takes normal course in order to be admit in an Hospice care.

Six (6) months

Sickle cell crisis A. Nociceptive B. Neuropathic

"Palliative care is both a ____________ of care and an organized, highly ___________ system for delivering care."

Philosophy and structured, respectively

Life prolonging care A. Palliative care B. Curative care C. Hospice care

Focuses on quality of life and death, and views death as a natural part of life A. Palliative cares B. Curative care

Affirms life and neither hastens nor postpones death A. Hospice care B. Curative care C. Palliative care

True or False. Hospice recognizes dying as part of the normal process of living

True

Complex Regional Pain Syndrome A. Nociceptive B. Neuropathic

Expected outcome is relief from distressing symptoms, easing the pain and/or enhancing the quality of life A. Hospice care B. Palliative care C. Curative care

Criteria for admission on Hospice care EXCEPT: A. Life on personal and service area B. Consent to accept service C. Life-limiting illness

A. it only manage the SERVICE area of a patient

Central post -stroke pain A. Nociceptive B. Neuropathic

Any persistent pain that has an impact on PHYSICAL, PSYCHOSOCIAL or quality of life should undergo _________________________

Comprehensive pain assessment

Patients with serious illness A. Curative care B. Hospice care C. Palliative care

Focuses on quantity of life and prolonging of life A. Palliative care B. Hospice care C. Curative care

What are 5 vital signs? (enumerate)

1. Temperature 2. Pulse 3. Blood pressure 4. Respiratory rate 5. Pain* (Joint Commission)

Common symptoms in Palliative care (enumerate)

"IN-APPS DUD" Incontinence Nausea Anorexia Pain Pruritis Seizures (intractable) Dyspnea Ulcers (pressure) Delirium

Caused by activity in neural pathway in response to potentially tissue-damaging stimuli A. Nociceptive pain B. mixed type C. Neuropathic pain

Initiated or caused by primary lesion or dysfunction in the nervous system A. Nociceptive B. mixed type C. Neuropathic pain

Treatment that enhances comfort and improves the quality of an individual's life during the last phase of life A. Curative care B. Hospice care C. Palliative care

For mild pain

NSAIDS, paracetamol, aspirin

If the pain persists, ____________ are used

Codeine, tramadol - weak opioids

For severe pain

Morphine, oxycodone, fentanyl - Strong opioids

In managing pain, what strategy is used for non-cancer patients?

Analgesic ladder

The most convenient and cost effective route in administrating medicine.

Oral administration

It provides slower absorption but with little first-pass effect

Rectal administration

``` Which route is preferred over IM injections? A. IV B. SC C. Both D. Neither ```

Most commonly used opioid in terminal ilness

Morphine

Usual effective dosage interval for opioid analgesics is _____________

3-4 hours

In morphine, reestablishing pain control when stable dose becomes inadequate ordinarily requires more than or equal to ___________ the previous dose

1.5 times

True or False. Taking morphine twice the stable tolerated dose will seriously depress neurologic function.

False. Respiratory function will more likely be depressed

Only opioid administered topically via patch

Fentanyl

``` Adverse effects of morphine EXCEPT: A. Nausea B. Sedation C. Confusion D. Delirium E. Constipation ```

At least, __________ is needed to attain maximum analgesia in fentanyl.

24 hours

Fentanyl releases opioid steadily for _________

72 hours

``` Cortical pathology: A. Problems localizing sounds B. Hearing loss for speech C. Language problems D. Problems with difficult speech ```

C and D

For severe pain in localized body regions

Anesthetics

It is placed on joints to provide continuous infusion of analgesics

Indwelling epidural or intrathecal catheters

``` Brainstem pathology: A. Problems with difficult in speech B. Language problems C. Problems in binaural listening D. Hearing loss for speech ```

Renally-cleared opioids

Morphine and hydromorphone

With addiction history, what opioid can be used?

Methadone

Causes of anorexia (enumerate)

"DRINCD" ---- DRINKED ``` Depression Radiotherapy Infection (mouth) Nausea Constipation Drugs ```

To alleviate nausea and vomiting, what medicines can be prescribed?

1. Metoclopromide orally or subcutaneously (useful for NAUSEA) 2. Promethazine 25 mg orally 4x a day 3. Prochlorperazine 10 mg orally before meals

Bed sores general treatment (enumerate)

A. Pressure reduction B. control of infection C. Debridement D. Dressings and nutritional support

A support system that serves as a nurse, homemaker, spouse and head of the household and more

Caregiver

A state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude

Caregiver burnout

Patient and family centered care A. Hospice care B. Palliative care C. Curative care

Causes of caregiver burnout (enumerate)

``` "RUUL" Role confusion Unrealistic expectations Unreasonable demands Lack of control ```

``` Major health concern for older adults. A. Hyponatremia B. MI C. Impaired mobility D. Pneumonia ```

C | Reason: affecting 50% of people over 85 and at least a quarter of those over 75

Mechanical low back pain A. Nociceptive B. Neuropathic pain

Care that is applicable early in the course of illness, in conjunction with other therapies intended to prolong life A. Curative care B. hospice care C. Palliative care

``` Factors affecting pain in the context of a person's life A. Hopes and fears for the future B. Pressure and support of the peers C. Social and economic realities D. Spiritual beliefs ```

B. Mas factor kapag FAMILY SUPPORT AND PRESSURE

Caused by a combination of both primary injury and secondary effects A. Nociceptive pain B. mixed type C. Neuropathic pain

``` Withdrawal, psychomotor retardation, sleep disturbance, suicidal ideation A. Shock and denial B. Depression C. Anger D. Bargaining ```