Exam #2: Etiology of Non-Pain Symptoms in Palliative Medicine Flashcards
When ordering medications for patients in a palliative medicine service, what do you need to remember?
1) Meds for disease
2) Meds to treat disease
3) Meds for comorbidities*
What are the symptoms that are commonly under treated in those requiring palliative medicine?
- Fatigue
- Depression
- Anorexia
- Early satiety
- Delerium
**Need to systematically ask about these things
How should you address non pain symptoms in palliative care patients?
- Choose the treatment strategy that is going to support the patient’s goals of care
- Identify the CAUSE of the symptom, and treat the cause
What are the considerations that need to be taken in goal setting?
1) Is it achievable?
2) Is the goal beneficial?
3) How will results be monitored?
What is the gold standard for assessment of dyspnea?
Patient self-report
What is the mnemonic used to identify the causes of dyspnea?
BREATH AIR B= bronchospasm R= rales E= effusion A= airway obstruction T= thick secretions H= Hb low
A= anxiety I= interpersonal issues R= religious concerns
How do we treat dyspnea?
Oxygen
Opioids (constipation)
Anxiolytics
CPAP/ BiPAP
What are the general measures for treating dyspnea?
Reduce exertion Reposition Skin care Improve circulation Address anxiety Pursed lip breathing
How do you tell the difference between neurologic or non-neurologic dysphagia?
Obstruction= solids progressing to liquids
Neurologic= both simultaneously
What is the mnemonic for the causes of anorexia?
ANOREXIA
A= aches & pain N= Nausea O= oral candidiasis R= reactive depression E= evacuation problem X= xerostomia (dry mouth) I= iatrogenic A= acid related i.e. GERD
Is artificial nutrition recommended?
No–can shorten life & does not have objective benefits
What are the four main paths to trigger the vomiting center?
1) ICP in cortex
2) Vestibular apparatus
3) Chemoreceptor
4) GI tract
What is the typical treatment for delirium?
Low dose non-sedating antipsychotics
**Be sure not to use BENZODIAZEPINE alone
