EOL care

Question 1

serious illness

Answer 1

health condition that carries a high risk of mortality and either negatively impacts a person’s daily function or QOL or excessively strains their career

Question 2

palliative care

Answer 2

focuses on assessment and management of pain and other symptoms, person can still receive curative treatments

Question 3

hospice care

Answer 3

provided to pts with life expectancy of < 6 months if disease takes its natural course

-main focus is on improving pt and family quality of life
-comprehensive care in variety of settings

Question 4

hospice settings

Answer 4

-pts private home
-assisted living
-long term facility
-in patient hospice
-hospice residential facility

Question 5

sudden death

Answer 5

occurs unexpectedly
-MI
-car accident

Question 6

chronic illness

Answer 6

pts with chronic illness who have periodic crisis and eventually die
-COPD / HF

**steady decline but can live for years

Question 7

progressive deterioration

Answer 7

pts with illness that cases a prolonged decline ending in death
-alzheimer’s

Question 8

weeks remaining care

Answer 8

1. decrease socialization
2. mental status change
3. decreased oral intake
4. fatigue
5. bedbound w/ potential skin breakdown
6. decrease function status

Question 9

days remaining care

Answer 9

1. oliguria or anuria
2. little / no response to auditory or visual stimuli
3. death rattle!!!
4. terminal lucidity - rally day : surge of energy before death
5. temperature fluctuations
6. increase HR
7. near death awareness experience - talking to those that have passed

Question 10

hours remaining care

Answer 10

1. cooling / mottling extremities
2. bradycardia
3. terminal secretions
4. prolonged apnea periods, cyanosis, waxy facial experience
5. obtundation- dulled LOC

Question 11

pain

Answer 11

unpleasant sensory and emotional experience associated with actual or potential tissue damage

**most feared symptoms of pts with serious illness

Question 12

barrier to pain relief - pts

Answer 12

-reluctance to report pain
-sensory impairments compromising communication
-concern about not being a “good” pt
-inability to pay for meds
-fear of addiction
-older = assume pain is normal

Question 13

barrier to pain relief - healthcare professional

Answer 13

-inadequate knowledge
-pain scales
-lack of continuity of care
-poor communication
-regulation of controlled substances
-potential for addiction

Question 14

barrier to pain relief- healthcare system

Answer 14

-fail to hold healthcare professionals accountable
-shorter length of hospitals stays
-lack culturally tailored pain scales
-lack policies to document pain assessment
-lack pain mgmt specialist
-restrictive opioid policies
-insurance
-limit access
-pharmacy deserts

Question 15

acute pain

Answer 15

1-3 months

Question 16

chronic pain

Answer 16

3-6 months

Question 17

nociceptive pain

Answer 17

r/t damage of bones, soft tissue, internal organs

-somatic and visceral

Question 18

neuropathic pain

Answer 18

generally d/t damage of nervous system

-burning , tingling , shooting

Question 19

OLD CARTS

Answer 19

onset
location
duration
character
alleviating / aggrivating
radiating
timing
symptoms

Question 20

pain physical exam

Answer 20

1. observation
2. palpation
3. percussion
4. auscultate

Question 21

pain reassessment

Answer 21

15-30 min after IV meds
1 hour after immediate release meds

**reassess using same pain scale as before

Question 22

acetaminophen (non-opioid)

Answer 22

analgesic and antipyretic
AE = liver dysfunction

**liver dysfunction gets no more than 2,000mg

Question 23

morphine (opioid)

Answer 23

pts with moderate to severe pain , first line

DO NOT give an unarousable pt a dose of morphine UNLESS pt is EOL and is being kept comfortable!!!!!

Question 24

sublingual morphine

Answer 24

5mg given every 15min until pt is comfortable

YOU WILL NOT kill them if giving them the correct amount

Question 25

opioid AE

Answer 25

constipation!!!
sedation
urinary retention
nv/
pruritis
myoclonus

Question 26

pain plan not working

Answer 26

ADVOCATE!
-increased doses
-different opioid
-additional analgesics

Question 27

pediatric pain

Answer 27

often mistreated r/t
-fear of addiction
-belief of no pain
-inappropriate knowledge

Question 28

pediatric pain signs

Answer 28

change in HR / BP / O2
withdrawn, irritable, not engaging

**TALK TO PARENTS they know what is normal

Question 29

withdrawing care (terminal weaning)

Answer 29

most common withheld medical intervention
pts may exhibit resp distress s/s

Question 30

improving palliative care

Answer 30

RN must be knowledgeable about benefits
provide compassion
alternative listener
advocate for family and pt
work with interprofessional team