End of Life Care Flashcards
1
Q
describe the trajectories seen
A
2
Q
describe hospice and palliative medicine
A
- affirms life, regards dying as normal
- team approach to enhance quality of life and positively influence course of illness
- offers support system to help patients live as acutely as possible until death
- relief from pain and distressing symptoms
3
Q
name the 5 key symptoms to control to optimize quality of life
A
- 5 key symptoms
- pain
- nausea and vomiting
- agitation
- dyspnea
- retained repiratory secretions (RTS)
- assess and respond to psychological, social and spiritual needs
4
Q
describe the goals for care of the dying adult
A
- clinically assisted feeding and hydration
- give by mouth for as long as possible
- may relieve distressing signs of dehydration
- unlikely to prolong life or the dying process
- review current medication
- anticipate need to change meds and routes of administration
- have readily available, note in prescription chart
- anticipate need to change meds and routes of administration
- a bad death that was avoidable is a failure
5
Q
describe the analgesic ladder
A
-
mild pain
- aspirin, acetominophen, NSAIDS
-
moderate pain
- aspirin, acetominophen + opioids (codeine, oxycodone, tramadol)
-
severe pain
- morphine, methadone, fentanyl, + nonopioid analgesics
6
Q
describe the CDC guideline for prescribing opioids for chronic pain
A
- before starting and periodically during opioid therapy, discuss with patients known risks, realistic benefits and responsibilties
- effectiveness and risks of long-term opioid therapy varies
- nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred
- before staring opioid therapy for chronic pain, establish realstic treatment for pain and function; consider how to discontinue if benefits do not outweight risks
7
Q
describe critical thinking skills
A
8
Q
what questions should be asked to elicit & document patient goals?
A
- what do you understand about your illness?
- how much do you want to know about what is likely to happen with your illness?
- who would you want to make decisions for you if you could not communicate?
- what are your most important goals now?
- what are your biggest fears and worries now?
9
Q
describe how physician should talk with patients during end of life care
A
- are there situations you would find unacceptable?
- how does your family feel about your preferences?
- encourage their questions and be prepared to answer them
- look up outcome data specific to the patient
- basis for prognosis and likely outcomes
- summarize your discussion
- “so let me see if I understand what you are saying…”
- make recommendation based on patient goals and medical realities
10
Q
globally, opiods are ___ and pain is _____
A
globally, opiods are underused and pain is undertreated
11
Q
explain why opioid use in clinics is low among healthcare practitioners
A