Communication with pts with serious illnesses Flashcards
What are the three causes of non-pain symptoms?
Disease processes
Treatments
Comorbidities
What are the characteristics of palliative care medicine?
Polysymptomatic
True or false: palliative care pts do not volunteer all of their symptoms
True
True or false: Symptom distress is not always in proportion to severity
True
What is the way to identify hidden symptoms in palliative care pts?
Screen for them
What is the way to identify clinical symptoms?
H&P
When is the PE done relative to the other steps of the clinical symptom assessment
Almost last
Treatments should be chosen based on what?
Goals of care
What can affect goals of care?
- age
- functional status
- overall needs
- rate or change of disease
- life expectancy
What should you always look for in non-pain symptoms, if possible?
The cause of the symptom
How should you approach treatment of a multitude of symptoms?
Starting with the one that causes the most distress
Why is it important to get caregivers involved in screening for symptoms?
Pts may diminish symptoms
Why is it important to document assessment and plan?
SO you can review what happens
for others
What are the three questions to ask in goal setting?
Are goals achievable
Are they beneficial
How measure
What are the eight common non-pain symtoms to focus on?
Constipation N/V Diarrhea BO Anorexia Delerium Depression Dyspnea
What happens to dyspnea as death approaches?
Worsens
True or false: dyspnea occurs commonly in a broad range of diseases
True
True or false: anxiety breeds anxiety
True
What is the gold standard for detecting dyspnea?
Self reporting
True or false: dyspnea is an objective finding
False-subjective
True or false: stats do no reflect dyspnea
True
What is the first step in treating dyspnea
Identifying the cause
Treatment of dyspnea depends on what (besides the cause)?
Prognosis and goals of care
What are the causes of dyspnea (BREATH AIR)
Bronchospasm Rales Effusion Airway obstruction Thick secretions Hemoglobin low Anxiety Interpersonal issues Religious concerns
How do we treat dyspnea pharmacologically?
Opioids
Anxiolytics
How do we treat dyspnea non-pharmacologically?
Oxygen
CPAP
Why should you not give high oxygen to CO2 retaining pts?
May lower their RR
What should you always write for when prescribing opioids?
Something to loosen stools
What are the general measures for treating dyspnea (that are not obvious)?
Skin care for buttocks
What is the position for treating dyspnea if they have a compromised lung?
Lie them down on the compromised lung
What is the MOA of cool air on the face reducing dyspnea?
Stimulation of CN V2
Why is pursed-lip breathing helpful?
Prolongs the expiration phase
What is the first step in treating dysphagia?
Determining if obstruction vs neurological
What is the treatment for dysphagia?
Good oral hygiene
Fix dentures
Calm down
True or false: taste disorders can cause dysphagia?
True
What type of foods should you avoid with dysphagia?
Sticky, hard or dry foods
What disease predisposes pts to anorexia?
CA
What is the first step in identifying anorexia?
Hx and PE
What are the reversible causes of anorexia? (ANOREXIA)?
Aches and pain Nausea Oral candida Reactive depression Evacuation problems Xerostomia Iatrogenic Acid-related
Why do you need to be careful with prescribing appetite stimulants?
many, many side-effects
What is the main thing to identify with artificial nutrition and hydration?
Goal of care
True or false: ANH improves healing process of decubitus ulcers?
False
True or false: ANH lengthens survival
False–opposite it usually true
What are the complications of ANH? (3)
Infections
Thrombosis
Aspiration
What is the perioperative mortality rate for PEG placement?
6-24%
True or false: N/V is very common in terminally ill pts, and is very distressing
True
What percent of pts can n/v be controlled?
90% of pts
What are the four parts of the body that cause vomiting?
Cerebral cortex
Vestibular apparatus
Chemoreceptors
GI tract
Where do all of the signals from the body go to trigger emesis?
Vomiting centers
How do you select antiemetics?
By identifying likely cause
What percent of malignant GI CAs have BO?
50%
What are the PE findings of a BO?
High pitched BS
What does the treatment for malignant BOs depend on?
Goals of care
expected outcome
What are the treatments of Malignant BOs? (3)
Surgery
Endoscope
Meds
What are the three types of altered levels of consciousness with delirium?
Hyperactive
Hypoactive
Mixed
What is the most important thing to do when treating delirium?
Inform family, b/c they think you are not doing anything
What is the usual pharm treatment for delirium?
low dose non-sedating antipsychotics
What is the med to avoid with delirium?
Benzos
What percent of critically ill pts develop delirium?
50%
How do you prevent delirium?
Prevent dehydration
Remove caths
Decrease stimuli
