Communication with pts with serious illnesses

Question 1

What are the three causes of non-pain symptoms?

Answer 1

Disease processes
Treatments
Comorbidities

Question 2

What are the characteristics of palliative care medicine?

Answer 2

Polysymptomatic

Question 3

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

Answer 3

True

Question 4

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

Answer 4

True

Question 5

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

Answer 5

Screen for them

Question 6

What is the way to identify clinical symptoms?

Answer 6

H&P

Question 7

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

Answer 7

Almost last

Question 8

Treatments should be chosen based on what?

Answer 8

Goals of care

Question 9

What can affect goals of care?

Answer 9

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

Question 10

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

Answer 10

The cause of the symptom

Question 11

How should you approach treatment of a multitude of symptoms?

Answer 11

Starting with the one that causes the most distress

Question 12

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

Answer 12

Pts may diminish symptoms

Question 13

Why is it important to document assessment and plan?

Answer 13

SO you can review what happens

for others

Question 14

What are the three questions to ask in goal setting?

Answer 14

Are goals achievable
Are they beneficial
How measure

Question 15

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

Answer 15

Constipation
N/V
Diarrhea
BO
Anorexia
Delerium
Depression
Dyspnea

Question 16

What happens to dyspnea as death approaches?

Answer 16

Worsens

Question 17

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

Answer 17

True

Question 18

True or false: anxiety breeds anxiety

Answer 18

True

Question 19

What is the gold standard for detecting dyspnea?

Answer 19

Self reporting

Question 20

True or false: dyspnea is an objective finding

Answer 20

False-subjective

Question 21

True or false: stats do no reflect dyspnea

Answer 21

True

Question 22

What is the first step in treating dyspnea

Answer 22

Identifying the cause

Question 23

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

Answer 23

Prognosis and goals of care

Question 24

What are the causes of dyspnea (BREATH AIR)

Answer 24

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

Question 25

How do we treat dyspnea pharmacologically?

Answer 25

Opioids | Anxiolytics

Question 26

How do we treat dyspnea non-pharmacologically?

Answer 26

Oxygen | CPAP

Question 27

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

Answer 27

May lower their RR

Question 28

What should you always write for when prescribing opioids?

Answer 28

Something to loosen stools

Question 29

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

Answer 29

Skin care for buttocks

Question 30

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

Answer 30

Lie them down on the compromised lung

Question 31

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

Answer 31

Stimulation of CN V2

Question 32

Why is pursed-lip breathing helpful?

Answer 32

Prolongs the expiration phase

Question 33

What is the first step in treating dysphagia?

Answer 33

Determining if obstruction vs neurological

Question 34

What is the treatment for dysphagia?

Answer 34

Good oral hygiene Fix dentures Calm down

Question 35

True or false: taste disorders can cause dysphagia?

Answer 35

True

Question 36

What type of foods should you avoid with dysphagia?

Answer 36

Sticky, hard or dry foods

Question 37

What disease predisposes pts to anorexia?

Answer 37

CA

Question 38

What is the first step in identifying anorexia?

Answer 38

Hx and PE

Question 39

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

Answer 39

``` Aches and pain Nausea Oral candida Reactive depression Evacuation problems Xerostomia Iatrogenic Acid-related ```

Question 40

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

Answer 40

many, many side-effects

Question 41

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

Answer 41

Goal of care

Question 42

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

Answer 42

False

Question 43

True or false: ANH lengthens survival

Answer 43

False--opposite it usually true

Question 44

What are the complications of ANH? (3)

Answer 44

Infections Thrombosis Aspiration

Question 45

What is the perioperative mortality rate for PEG placement?

Answer 45

6-24%

Question 46

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

Answer 46

True

Question 47

What percent of pts can n/v be controlled?

Answer 47

90% of pts

Question 48

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

Answer 48

Cerebral cortex Vestibular apparatus Chemoreceptors GI tract

Question 49

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

Answer 49

Vomiting centers

Question 50

How do you select antiemetics?

Answer 50

By identifying likely cause

Question 51

What percent of malignant GI CAs have BO?

Answer 51

50%

Question 52

What are the PE findings of a BO?

Answer 52

High pitched BS

Question 53

What does the treatment for malignant BOs depend on?

Answer 53

Goals of care | expected outcome

Question 54

What are the treatments of Malignant BOs? (3)

Answer 54

Surgery Endoscope Meds

Question 55

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

Answer 55

Hyperactive Hypoactive Mixed

Question 56

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

Answer 56

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

Question 57

What is the usual pharm treatment for delirium?

Answer 57

low dose non-sedating antipsychotics

Question 58

What is the med to avoid with delirium?

Answer 58

Benzos

Question 59

What percent of critically ill pts develop delirium?

Answer 59

50%

Question 60

How do you prevent delirium?

Answer 60

Prevent dehydration Remove caths Decrease stimuli