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PCM Last Exam > End of Life - Unrein > Flashcards

End of Life - Unrein Flashcards

1
Q

hospes

A

relationship between host and guest

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2
Q

pallium

A

outer garment

tx of sx of those with life threatening illness

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3
Q

cecily saunders

A

started hospice - 1967

great britain

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4
Q

study of and care for patients with active, progressive, far-advanced disease whose prognosis is limited - focus is quality of life

A

hospice

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5
Q

palliative care

A

relieve/sooth sx of disease or disorder

any age / any stage of illness

not just when can’t be cured

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6
Q

synonyms for palliative care

A

comfort care

supportive care

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7
Q

hospice

A

does not hasten death

does not take away all meds

is whats right for pt

pt can change mind - to seek aggressive therapy

withdrawal food/nutrition - does not mean murder

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8
Q

double effect

A

too much pain med can cause death - cannot be arrested

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9
Q

hospice criteria

A

terminal illness
ex/cancer, HIV, cardiac disease, pulm disease, renal disease, liver disease, neuromuscular disease, stroke/coma, dementia

less than 6 months to live**

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10
Q

hospice team

A

interdisciplinary

physician, nurse, diet counselor, social worker, chaplin, etc.

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11
Q

end of life planning

A

durable power of attorney

DNR

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12
Q

DNR vs. DNAR

A

do not attempt resuscitate

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13
Q

AND

A

allow natural death

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14
Q

POLST/MOST

A

declaration of what patient wants

legal binding document

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15
Q

ethical principles

A

autonomy - pt decision
beneficence - serve pt well being
nonmaleficence - do no harm
justice - fairness

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16
Q

competence

A

legal term

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17
Q

capacity

A

medical term

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18
Q

futility

A

conflict due to misunderstanding

pointless or uselessness

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19
Q

primum non nocere

A

do no harm

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20
Q

double effect

A

action causing serious harm - as side effect of promoting some good end

based on caregivers intent

21
Q

euthanasia

A

when physician DIRECTLY ends pt life

22
Q

physician assisted suicide

A

now known as physician assisted death

in oregon, washington, montana, vermont, new mexico

physician HELPS pt take their life

23
Q

total pain

A

beyond that just physical

spiritual, psych, social pain
-non-physical

24
Q

2 roads to death

A

difficult

usual - sleepy, lethargic, obtunded, comatose

25
Q

physical pain

A

tx first - to address other sources of pain

26
Q

somatic pain

A

aching
stabbing
throbbing

well localized

27
Q

visceral pain

A

cramping, squeezing, poor localized

28
Q

neuropathic pain

A

burning, shooting, tingling, numbness

29
Q

opioids

A

mu, kappa, delta receptors PNS and CNS

inhibit Ca channels - release of substance P

modulate sensation of shortness of breath in resp center

DOC - pt near end of life with severe pain

30
Q

mild to moderate pain

A

codeine

hydrocodone

31
Q

moderate to severe pain

A 
morphine
hydromorphone
oxycodone
fentanyl
methadone (also NMDA antagonist)
32
Q

IM

A

undesirable route of admin for opioids

33
Q

meperidine

A

demerol

toxic metabolites
bad drug
avoid it

34
Q

side effects of opioids

A

constipation - never get used to this

nausea, somnolence, myoclonus

35
Q

morphine neurotoxicity

A

3 glucuronide - toxic

36
Q

adjuvants to pain meds

A 
corticosteroids
acetaminophen
anticholinergics - bowel problems
antidepressants
NSAIDs
anticonvulsants
antiarrhythmics
37
Q

palliative sedation

A

last resort to stop pain

aka terminal sedation

allow pt die peacefully from natural course of illness

allow wind down period

rendering pt unconscious

38
Q

methylnaltrexone

A

opioid antagonist
-cannot cross BBB

tx constipation
-blocks bowel - not brain

39
Q

dyspnea

A

respond well to systemic opioids

proper position, O2, a fan

worst feeling second to pain

40
Q

nausea

A

cerebral cortex - emotion, malignancy, ICP, pain

vestibular

chemotherapy

tx - dexamethasone, counsel, anti-anxiety, antidepressant, opioid

41
Q

tx nausea

A

ondansetron

5-HT3

42
Q

cannabinoids

A

hallucinogenic

THC and CBD

dronabinol - synthetic - not that potent

43
Q

patient need

A

permission to die

44
Q

hospice and palliative medicine

A

specialty

-need to do 1 year fellowship

45
Q

tx nausea

A

dexamethasone

46
Q

tx vestibular nausea

A

antibiotic
anticholinergic
antihistamine

47
Q

tx delirium

A

antipsychotic
haldoperidol
chlopromazine
benzos

48
Q

palliative sedation

A

midazolam, propofol, thiopental

PCM Last Exam (6 decks)

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