End of Life Care - Block 4

Question 1

What is palliative care?

Answer 1

Comfort care:
* To improve QoL with or w/o a curative tx

Question 2

How does hospice differ from palliative care?

Answer 2

Making a patient with a terminal illness feel comfortable as they come closer to death

Question 3

How qualifies for hospice?

Answer 3

1. Patients with <6 months to live
2. Rapidly declining health despite treatment
3. Patients ready to live more comfortably and forego tx aimed to prolong life

Question 4

How is a part of the hospice care team?

Answer 4

1. Volunteers
2. Bereavement counselors
3. Lawyers

Question 5

Issues managed during hospice?

Answer 5

1. Pain
2. SOB
3. Nausea
4. Constipation
5. Fatigue
6. Decreased appetite
7. Sleep issues

Question 6

What is the difference between nociceptive and neuropathic pain?

Answer 6

Nociceptive: actual or potential tissue damge (achy, throbbing, dull)
Neuropathic: Damage to NS (tingling, burning, shock-like)

Question 7

What is the tx for nociceptive vs neuropathic pain?

Answer 7

Nociceptive: Opioids
* Moderate –> Increase of 25% to 50%
* Severe –>Increase of 50% to 100%

Neuropathic: TCA, SNRI, gabapentinoids, opioids

Question 8

Describe a scheduled opioid regimen?

Answer 8

Basal of LA opioid starts at 50-75% of patient’s total 24 hr opioid requirement

Question 9

Describe a PRN opioid regimen?

Answer 9

Breakthrough or short-acting opioid is started at a dose representing 10-20% of 24 hr opioid requirements

Question 10

What is dyspnea?

Answer 10

Sensation of breathlessness

Question 11

Nonpharm for dyspnea?

Answer 11

1. Use a fan to face
2. Pulmonary rehab
3. Relaxation therapy
4. Repositioning

Question 12

What is the treatment for dyspnia?

Answer 12

Opioids

Question 13

What is the tx for constipation?

Answer 13

Laxatives: bulk is not recommended

Question 14

What is the tx for N/V?

Answer 14

1. Haloperidol
2. Olanzapine
3. Scapolamine

Question 15

What is the tx for anxiety?

Answer 15

1. SSRI
2. BZD

Question 16

What is the tx for hypoactive delirium?

Answer 16

1. Patient reorientation
2. Maintenance of slee-wake
3. Presense of family
4. Assistive devices

Question 17

What do you use for oral secretions?

Answer 17

Anticholinergics

Question 18

When do you use stilumants?

Answer 18

Drowsiness and sedation

Question 19

What are life susaining treatments?

Answer 19

1. CPR
2. Ventilation
3. Tube feeding
4. Dialysis

Question 20

WHat is advanced care planning?

Answer 20

process ensurng that your end-of-life care wishes are honored if you are unable to communicate them

Question 21

What is the power of attorneys responsiblity overruled?

Answer 21

Presense of a living will

Question 22

Define the inmplications of physician assissted death?

Answer 22

A physician providing, at the patient’s request, a prescription for a lethal dose of medication that the patient can self-administer through ingestion, with the explicit intention of ending life.

Question 23

WHat qualifies for PAD?

Answer 23

1. Having <6 months to live
2. Must be a residant of a state that leglizes it
3. > 18 YO
4. Must be able to self administer or ingest med

Question 24

What prscriptions would you used in PAD?

Answer 24

Oral barbs: secobarbital, pentobarbital
Combo: digoxin, diazepam, morphine, propranol (DDMP2)

Question 25

What is the counseling for lethal scripts??

Answer 25

1. Take an empty stomach
2. Give antiemetic 1 hr prior
3. Proper medication disposal methods if patient should change their mind

Question 26

When should you complete and submit a dispensing form for lethal doses

Answer 26

Within 10 of dispensing