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Geriatrics > Communication with pts with serious illnesses > Flashcards

Communication with pts with serious illnesses Flashcards

1
Q

What are the three causes of non-pain symptoms?

A

Disease processes
Treatments
Comorbidities

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2
Q

What are the characteristics of palliative care medicine?

A

Polysymptomatic

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3
Q

True or false: palliative care pts do not volunteer all of their symptoms

A

True

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4
Q

True or false: Symptom distress is not always in proportion to severity

A

True

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5
Q

What is the way to identify hidden symptoms in palliative care pts?

A

Screen for them

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6
Q

What is the way to identify clinical symptoms?

A

H&P

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7
Q

When is the PE done relative to the other steps of the clinical symptom assessment

A

Almost last

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8
Q

Treatments should be chosen based on what?

A

Goals of care

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9
Q

What can affect goals of care?

A
  • age
  • functional status
  • overall needs
  • rate or change of disease
  • life expectancy
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10
Q

What should you always look for in non-pain symptoms, if possible?

A

The cause of the symptom

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11
Q

How should you approach treatment of a multitude of symptoms?

A

Starting with the one that causes the most distress

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12
Q

Why is it important to get caregivers involved in screening for symptoms?

A

Pts may diminish symptoms

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13
Q

Why is it important to document assessment and plan?

A

SO you can review what happens

for others

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14
Q

What are the three questions to ask in goal setting?

A

Are goals achievable
Are they beneficial
How measure

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15
Q

What are the eight common non-pain symtoms to focus on?

A 
Constipation
N/V
Diarrhea
BO
Anorexia
Delerium
Depression
Dyspnea
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16
Q

What happens to dyspnea as death approaches?

A

Worsens

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17
Q

True or false: dyspnea occurs commonly in a broad range of diseases

A

True

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18
Q

True or false: anxiety breeds anxiety

A

True

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19
Q

What is the gold standard for detecting dyspnea?

A

Self reporting

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20
Q

True or false: dyspnea is an objective finding

A

False-subjective

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21
Q

True or false: stats do no reflect dyspnea

A

True

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22
Q

What is the first step in treating dyspnea

A

Identifying the cause

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23
Q

Treatment of dyspnea depends on what (besides the cause)?

A

Prognosis and goals of care

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24
Q

What are the causes of dyspnea (BREATH AIR)

A 
Bronchospasm
Rales
Effusion
Airway obstruction
Thick secretions
Hemoglobin low
Anxiety
Interpersonal issues
Religious concerns
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25
Q

How do we treat dyspnea pharmacologically?

A

Opioids

Anxiolytics

26
Q

How do we treat dyspnea non-pharmacologically?

A

Oxygen

CPAP

27
Q

Why should you not give high oxygen to CO2 retaining pts?

A

May lower their RR

28
Q

What should you always write for when prescribing opioids?

A

Something to loosen stools

29
Q

What are the general measures for treating dyspnea (that are not obvious)?

A

Skin care for buttocks

30
Q

What is the position for treating dyspnea if they have a compromised lung?

A

Lie them down on the compromised lung

31
Q

What is the MOA of cool air on the face reducing dyspnea?

A

Stimulation of CN V2

32
Q

Why is pursed-lip breathing helpful?

A

Prolongs the expiration phase

33
Q

What is the first step in treating dysphagia?

A

Determining if obstruction vs neurological

34
Q

What is the treatment for dysphagia?

A

Good oral hygiene
Fix dentures
Calm down

35
Q

True or false: taste disorders can cause dysphagia?

A

True

36
Q

What type of foods should you avoid with dysphagia?

A

Sticky, hard or dry foods

37
Q

What disease predisposes pts to anorexia?

A

CA

38
Q

What is the first step in identifying anorexia?

A

Hx and PE

39
Q

What are the reversible causes of anorexia? (ANOREXIA)?

A 
Aches and pain
Nausea
Oral candida
Reactive depression
Evacuation problems
Xerostomia
Iatrogenic
Acid-related
40
Q

Why do you need to be careful with prescribing appetite stimulants?

A

many, many side-effects

41
Q

What is the main thing to identify with artificial nutrition and hydration?

A

Goal of care

42
Q

True or false: ANH improves healing process of decubitus ulcers?

A

False

43
Q

True or false: ANH lengthens survival

A

False–opposite it usually true

44
Q

What are the complications of ANH? (3)

A

Infections
Thrombosis
Aspiration

45
Q

What is the perioperative mortality rate for PEG placement?

A

6-24%

46
Q

True or false: N/V is very common in terminally ill pts, and is very distressing

A

True

47
Q

What percent of pts can n/v be controlled?

A

90% of pts

48
Q

What are the four parts of the body that cause vomiting?

A

Cerebral cortex
Vestibular apparatus
Chemoreceptors
GI tract

49
Q

Where do all of the signals from the body go to trigger emesis?

A

Vomiting centers

50
Q

How do you select antiemetics?

A

By identifying likely cause

51
Q

What percent of malignant GI CAs have BO?

A

50%

52
Q

What are the PE findings of a BO?

A

High pitched BS

53
Q

What does the treatment for malignant BOs depend on?

A

Goals of care

expected outcome

54
Q

What are the treatments of Malignant BOs? (3)

A

Surgery
Endoscope
Meds

55
Q

What are the three types of altered levels of consciousness with delirium?

A

Hyperactive
Hypoactive
Mixed

56
Q

What is the most important thing to do when treating delirium?

A

Inform family, b/c they think you are not doing anything

57
Q

What is the usual pharm treatment for delirium?

A

low dose non-sedating antipsychotics

58
Q

What is the med to avoid with delirium?

A

Benzos

59
Q

What percent of critically ill pts develop delirium?

A

50%

60
Q

How do you prevent delirium?

A

Prevent dehydration
Remove caths
Decrease stimuli

Geriatrics (30 decks)

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