Death and Dying

Question 1

What is a large reason that palliative care is initiated late?

Answer 1

Pain is not assessed early on/frequently enough

Question 2

How is hospice delivered?

Answer 2

interprofessional manner with a holistic approach

Question 3

What is included in the five wishes?

Answer 3

The person I want to make care decisions for me when I can’t
The kind of medical treatment I want or don’t want
How comfortable I want to be
How I want people to treat me
What I want my loved ones to know

Question 4

What are examples of tier 1 symptom management?

Answer 4

Mind-body therapies
Nutritional therapies
Natural products
Supplements
Integrative nursing therapies

Question 5

What are examples of tier 2 symptom management?

Answer 5

movement therapies
nutritional therapies
natural products and herbs

Question 6

What are examples of tier 3 symptom management?

Answer 6

mind-body therapies
energy therapies
health coaching
manipulative therapies

Question 7

What is tier 4 symptom management?

Answer 7

whole systems

Question 8

What is tier 5 symptom management?

Answer 8

pharmacological therapies
psychotherapy/behavioral therapy
Other invasive therapies

Question 9

What medications can be given for bladder spasms?

Answer 9

oxybutynin
prostaglandins

Question 10

Which medications can be used to treat rectal spams?

Answer 10

diltiazem
clonidine
benzos

Question 11

Which medications can be given to treat colicky pain due to bowel obstruction?

Answer 11

scopalamine
octrotide

Question 12

What are bisphophonates used for?

Answer 12

inhibit osteoclastic activity

Question 13

What occurs with circulatory depression secondary to opioid use?

Answer 13

orthostatic hypotension d/t dilating action of opioids on peripheral vascular system

Question 14

Why does urinary retention occur with opioid use?

Answer 14

increased smooth muscle tone of detruser muscle of bladder

Question 15

Why do cutaneous effects, such as pruritus, flushing, and sweating occur with opioid use?

Answer 15

histamine release d/t opioids

Question 16

Why does respiratory depression occur with opioid use?

Answer 16

Decreased sensitivity of respiratory center to CO2 (< 8bpm)

Question 17

Why does dyspnea occur at the EOL?

Answer 17

Narrowing of airways d/t bronchial constriction from swelling, tumor invasion or decreased alveolar function d/t fluid retention, tumor invasion

Question 18

What are examples of non-pharm treatments for pruritis?

Answer 18

Keep room humidity @ 30 – 40%
Cool room temperature
Fans/ moving air
Cotton & loose fitting clothing
Hypoallergenic soap
Avoid alcohol & spicy foods
Hydration (3000ml/ day)
Keep skin lubricated

Question 19

What are factors that may cause delirium at the EOL?

Answer 19

Medications (opioids, benzodiazepines)
Hypoxia
Dehydration
Metabolic (hypercalcemia, hyponatremia)
Sepsis
Polypharmacy
Intracranial pressure

Question 20

What are the neuro indicators of imminent death?

Answer 20

decreased verbal response, agitation, restlessness

Question 21

What are the cardiac indicators of imminent death?

Answer 21

increased/ irregular HR, decreased BP, widening pulse pressure, dehydration

Question 22

What are the pulmonary indicators of imminent death?

Answer 22

increased RR, dyspnea, increased use accessory muscles, Cheyne-Stokes respirations, noisy breathing

Question 23

What does CARES stand for on the EOL cares tool?

Answer 23

C = Comfort
A = Airway
R = Restlessness and delirium
E = Emotional and spiritual care
S = Self care for care providers