End of Life Care (Exam 3 Cut Off) Flashcards
1
Q
Palliative Care
A
- Specialized medical care for people with serious illness that focuses on relief form pain, symptoms, and distress due to illness
- Can be provided at the same time as curative care
- Any age or stage of illness
2
Q
Hospice
A
- Type of care and a philosophy or care that focuses on palliation of a terminally ill patient’s symptoms
- All is palliative care but not vice versa
3
Q
Terminal Illness
A
Estimate survival of 6 months or less
4
Q
Supportive Care
A
- Extra layer of support
- Focuses on intensive family meetings and patient/family counseling
- Resolves questions and conflicts between family/patients and physicians on achievable goals of care
- Expertise in pain and symptom management
5
Q
Medicare Hospice Benefit
A
- Passed by Congress in 1982
- 4 criteria patients must meet to enroll
- Certification periods: eligible for two 90-day periods initially, re-certification every 60 days thereafter with terminally ill certification from physician
6
Q
Hospice Benefit Criteria
A
- Eligible for Medicare Part A
- Medicare approved hospice program
- Signed statement by patient choosing hospice care instead of “regular” Medicare
- Certification by physicians and hospice medical director of terminal illness
7
Q
Symptom Management Principles
A
- Frequent, standard assessment
- Oral meds when possible and altering routes when needed
- Assess for SE and anticipate/treat them as needed
- D/C meds no longer contributing to symptom control
- Address possible reversible contributing causes
8
Q
Approach to Symptom Management
A
- Identify potential causes of symptom
- May require history, physical exam, labs, etc.
- Treat underlying cause and symptom if possible
- Re-evaluate frequently
9
Q
N/V Assessment/Approach
A
- Self-report is gold standard for nausea
- Documentation of vomiting/retching and associated symptoms, triggers, durations, severity
- Monitor food intake, hydration status, and bowel movements
- Documentation of relief from medications
10
Q
Opioid-Induced Constipation
A
First Line Options
- Stimulant laxatives (Senna or Bisacodyl)
- Osmotic laxatives (Polyethylene glycol or Lactulose)
Additional PRN Agents
- Bisacodyl suppository
- Magnesium
- Evaluation for ileus
- Low/high impaction
NOT DOCUSATE - no proven benefit
11
Q
Malignant Bowel Obstruction
A
- Common with abdominal cancers
- Symptoms: N/V, pain, distention, constipation or liquid stools
12
Q
Malignant Bowel Obstruction Treatment
A
Treatment Goal: eliminate need for NG tube/IV hydration
-Palliative surgery
Medications
- Opioids and antiemetics for pain and N/V
- Anticholinergics/antimuscarinics for colic pain (glycopyrrolate or hyoscyamine)
- Octreotide
- Corticosteroids (dexamethasone)
13
Q
Dyspnea
A
- Discomfort in breathing - common symptom in advanced cancer or illnesses
- Evaluated by subjective responses
- Could be physical, chemical, or neurological in causation
14
Q
Dyspnea Non-Pharm Treatment
A
- Re-positioning
- Maintaining cool room temperatures
- Relaxation exercises
- Acupuncture
- Minimal exertion
15
Q
Dyspnea Pharm Treatment
A
- Oxygen for documented hypoxia
- Opioids - first line, morphine is most commonly used and nebulized route not shown to be superior, no optimal agent
- Anxiolytics: Benzos reserved for breakthrough or refractory dyspnea affected by anxiety or unable to titrate opioids
