End of Life - Unrein

Question 1

hospes

Answer 1

relationship between host and guest

Question 2

pallium

Answer 2

outer garment

tx of sx of those with life threatening illness

Question 3

cecily saunders

Answer 3

started hospice - 1967

great britain

Question 4

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

Answer 4

hospice

Question 5

palliative care

Answer 5

relieve/sooth sx of disease or disorder

any age / any stage of illness

not just when can’t be cured

Question 6

synonyms for palliative care

Answer 6

comfort care

supportive care

Question 7

hospice

Answer 7

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

Question 8

double effect

Answer 8

too much pain med can cause death - cannot be arrested

Question 9

hospice criteria

Answer 9

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

less than 6 months to live**

Question 10

hospice team

Answer 10

interdisciplinary

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

Question 11

end of life planning

Answer 11

durable power of attorney

DNR

Question 12

DNR vs. DNAR

Answer 12

do not attempt resuscitate

Question 13

AND

Answer 13

allow natural death

Question 14

POLST/MOST

Answer 14

declaration of what patient wants

legal binding document

Question 15

ethical principles

Answer 15

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

Question 16

competence

Answer 16

legal term

Question 17

capacity

Answer 17

medical term

Question 18

futility

Answer 18

conflict due to misunderstanding

pointless or uselessness

Question 19

primum non nocere

Answer 19

do no harm

Question 20

double effect

Answer 20

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

based on caregivers intent

Question 21

euthanasia

Answer 21

when physician DIRECTLY ends pt life

Question 22

physician assisted suicide

Answer 22

now known as physician assisted death

in oregon, washington, montana, vermont, new mexico

physician HELPS pt take their life

Question 23

total pain

Answer 23

beyond that just physical

spiritual, psych, social pain
-non-physical

Question 24

2 roads to death

Answer 24

difficult

usual - sleepy, lethargic, obtunded, comatose

Question 25

physical pain

Answer 25

tx first - to address other sources of pain

Question 26

somatic pain

Answer 26

aching stabbing throbbing well localized

Question 27

visceral pain

Answer 27

cramping, squeezing, poor localized

Question 28

neuropathic pain

Answer 28

burning, shooting, tingling, numbness

Question 29

opioids

Answer 29

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

Question 30

mild to moderate pain

Answer 30

codeine | hydrocodone

Question 31

moderate to severe pain

Answer 31

``` morphine hydromorphone oxycodone fentanyl methadone (also NMDA antagonist) ```

Question 32

IM

Answer 32

undesirable route of admin for opioids

Question 33

meperidine

Answer 33

demerol toxic metabolites bad drug avoid it

Question 34

side effects of opioids

Answer 34

constipation - never get used to this nausea, somnolence, myoclonus

Question 35

morphine neurotoxicity

Answer 35

3 glucuronide - toxic

Question 36

adjuvants to pain meds

Answer 36

``` corticosteroids acetaminophen anticholinergics - bowel problems antidepressants NSAIDs anticonvulsants antiarrhythmics ```

Question 37

palliative sedation

Answer 37

last resort to stop pain aka terminal sedation allow pt die peacefully from natural course of illness allow wind down period rendering pt unconscious

Question 38

methylnaltrexone

Answer 38

opioid antagonist -cannot cross BBB tx constipation -blocks bowel - not brain

Question 39

dyspnea

Answer 39

respond well to systemic opioids proper position, O2, a fan worst feeling second to pain

Question 40

nausea

Answer 40

cerebral cortex - emotion, malignancy, ICP, pain vestibular chemotherapy tx - dexamethasone, counsel, anti-anxiety, antidepressant, opioid

Question 41

tx nausea

Answer 41

ondansetron 5-HT3

Question 42

cannabinoids

Answer 42

hallucinogenic THC and CBD dronabinol - synthetic - not that potent

Question 43

patient need

Answer 43

permission to die

Question 44

hospice and palliative medicine

Answer 44

specialty | -need to do 1 year fellowship

Question 45

tx nausea

Answer 45

dexamethasone

Question 46

tx vestibular nausea

Answer 46

antibiotic anticholinergic antihistamine

Question 47

tx delirium

Answer 47

antipsychotic haldoperidol chlopromazine benzos

Question 48

palliative sedation

Answer 48

midazolam, propofol, thiopental