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Palliative and EOLC > Final > Flashcards

Final Flashcards

1
Q

Pain

A

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

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2
Q

Total Pain

A

Physical, psychological, spiritual, and social dimensions of suffering

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3
Q

Cicely Saunders

A

Bio-psycho-social-spiritual model. Existential experience effected by gender, culture and SES

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4
Q

PC team members in order

A

RN, doc, social worker, homecare RN, spiritual, pharmacist, PT/OT, nurse practitioner, volunteers

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5
Q

Allodynia

A

Pain in response to normally non-pianful stimulus. Light pressure

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6
Q

Dysaesthesia

A

Unpleasant, abnormal sensation that is spontaneous or provoked. May have precipitating factors

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7
Q

Hyperalgesia

A

Exaggerated response to painful stimulus. Super pain

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8
Q

Hyperesthesia

A

Increased sensitivity to any stimulus

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9
Q

Hyperpathia

A

Abnormally painful reaction to a trigger. Explosive and delayed, poorly localized.

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10
Q

Parasthesia

A

Abnormal sensation, spontaneous or provoked but not unpleasant

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11
Q

Nociceptive Pain

A

Tissue damage from injury or pathology

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12
Q

Visceral pain

A

Referred pain. Colicky and episodic in the gut. Dull aching pain in parenchymal organs

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13
Q

Somatic pain

A

Well localized, aching, burning, throbbing

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14
Q

Neuropathic pain

A

Injury in CNS/PNS from development of abnormal nociceptive perception or transmission

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15
Q

Which type of pain has a weak response to opioids

A

Neuropathic

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16
Q

Background Pain

A

Baseline/basal. Constant, lasting more than 12 hours a day

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17
Q

Breakthrough pain

A

Exacerbation on a background of stable pain. Flare up or transient pain

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18
Q

Paroxysmal

A

Occurs unexepectedly

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19
Q

Incident pain

A

Precipitated and related to specific events

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20
Q

Volitional pain

A

Provoked by voluntary action like reaching

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21
Q

Non-volitional

A

Caused by involuntary action like coughing

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22
Q

Procedural pain

A

Related to intervention like wound dressing

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23
Q

End of Dose Failure

A

Pain occuring between doses of analgesics

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24
Q

Nociception

A

Activation of specialized nerve endings by mechanical, thermal or chemical stimuli

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25
Q

Nerve fibres

A

A,B and C fibres with alpha, beta, gamma and delta subcategories

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26
Q

A beta

A

6-12 myelination (thickest)
35-90 m/s conduction (fastest)
senses touch

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27
Q

A delta

A

1-5 myelination
5-40 conduction
thermal/mechanical, pricking, pinching

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28
Q

C

A

0-1.5 unmyelinated
0.2-2 conduction
mech/thermal throbbing and diffuse pain

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29
Q

Ascending pain pathway

A 
Dorsal horn of spinal cord
Raphe nuclei
Reticular formation 
PeriQ Gray matter
Hypothalamus
Cerebrum
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30
Q

Descending pain pathway

A 
Cerebrum
PeriQ gray matter
Midbrain
Medulla
Dorsal horn of spinal cord 
Afferent fibres
Nerve endings
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31
Q

Gate control

A

Sensory afferent nerve fibres inhibit transmission of painful stimuli to thalamus and cortex

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32
Q

Opioid receptors

A

Distributed throughout body. Mostly in CNS. Antagonized by naloxone. Mu, kappa, delta, ORL-1

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33
Q

Mu

A

Analgesia
Respiratory repression
Reduced GI motility
Hypotension

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34
Q

Kappa

A

Analgesia
Respiratory Repression
Sedation
Psychometric Effects

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35
Q

Delta

A

Analgesia

Respiratory repression

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36
Q

Pain assesment

A

Documentation of observed behavior to share with team. Reassess as pain changes

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37
Q

Suffering

A

State of distress brought by real/ perceived threat to fulfill hopes and expectations for life plan

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38
Q

Things to record in pain

A 
Sire, severity, raditiation
Timing, frequency, variation
Quality--> throbbing, burning
Associated Symptoms
Patient concerns
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39
Q

5 single pain scales

A 
Numerical Rating scale
Visual analogue scale
Brief pain inventory
Edmonton Symptom assessment system 
Leeds Assessment Neuropathic symptoms and signs
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40
Q

6 pain management principles

A 
Communication
Modify cause
Raise pain threshold 
Modify environment and support AODL
Modify pain perception with drugs
Interrupt pain pathway--> nerve blockers
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41
Q

3 types of analgesics in Palliative Care Formulary

A

NSAID
Opiates
Adjuvant

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42
Q

NSAID

A

Non-opioids, paracetamol, aspirin, operate as local anasthetic lower down

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43
Q

Opioid

A

Exert effects on opioid receptors in CNS, antagonized by naloxon

44
Q

Opiate

A

Naturally occuring, derived from poppy

45
Q

Adjuvant

A

Primary purpose is not analgesia but it does have relieving effects

46
Q

2 Opioid reccomendations

A

Give orally

Give on a clock and not as needed

47
Q

3 steps in WHO analgesic ladder

A

NSAID + adjuvant
Moderate opioid + adjuvant +NSAID
Strong opioid + NSAID +adjuvant

48
Q

% of dementia patients experiencing regular pain

A

50%

Rises to 80% as cognitive impairment increases

49
Q

Proxy measures

A

Observe current behavior, compare to previous condition

50
Q

2 pain assesment scales for dementia

A

Pain assesment in advanced dementia scale (PAINAD)

Pain assesment checklist for sensiors with limited ability to communicate (PACSLAC)

51
Q

Palliative Sedation Therapy

A

Used to control intolerable suffering and refractory symptoms such as pain, nausea, delirium and dyspnea. Fatigue, existential suffering

52
Q

Goal of PST

A

Alter consciousness and symptom palliation. Goal is not pain control

53
Q

Most common reasons for request of PST

A

Non-physcial symptoms and breathlessness

54
Q

4 drugs groups used in PST

A

Anxiolytic sedatives
Antipsychotics
Antiepileptics
General anesthesia

55
Q

Proportionality

A

Dose adjusted based on patient distress

56
Q

Sudden sedation

A

Deep sleep to control bretahlessness or delirium. Usually with benzodiazipiens

57
Q

PST Doctrine of the double effect

A

Intervention is proportionate to the desired outcome and the beneficial effect is more likely than the harmful one

58
Q

3 Ethical issues in PST

A

Linked to expedition of detah, slow euthanasia
Lack of research, cant test placebo
Shouldnt be used for non-physical symp.

59
Q

Continuous PST Canada

A

Should only be used in the last 2 weeks of life and only if symptoms are refractory. Used as alternative to euthanasia. Lack of laws

60
Q

Bill 52 Terminal Palliative sedation

A

Patient/SDM must know prognosis, irreversible nature of sedation and anticipated duration. Must be in writing

61
Q

3 clarifications needed in CPST

A

Target symptoms
Target population
Drugs to be used

62
Q

Ordinary sedation

A

Control non-physical symptoms like anxiety at any point

63
Q

Proportional sedation

A

Use benzos to proportionally conttol sufferring by reducing conciousness

64
Q

Palliative sedation to unconciousness

A

Given rapidly, remain under until death

65
Q

8 inconsistencies in sedation guidelines

A 
Definition
Indication
Timing/prognosis
Level/pattern of sedation 
Drugs used
To consider mental suffering 
To continue life sustaining therapies
66
Q

Medical Assiastance In Dying

A

Euthanaisa or PAS

67
Q

Sue Rodriguez 1993

A

Application for MAID dismissed by supreme court

68
Q

Carter vs Carter 2015

A

Supreme court changed criminal code to comply with the Charter of Rights and Freedom

69
Q

% of Canadians in favor of MAID

A

75% in 1994

67% in 2010

70
Q

4 federal conditions for MAID

A

Eligible for government funded health services
18, competent and with a grevous, irremediable medical condition
Natural death is reasonably forseeable
Make the request without external pressure

71
Q

Grevous medical condition

A

Advanced state of irreversible decline in capacity

Enduring suffering that is intolerable and not relieved by any acceptable condition

72
Q

3 steps to MAID

A

Patient signs form to make request
Request signed by 2 witnesses and approved by a second doctor
Wait 10 days before service performed

73
Q

5 differences in Quebec Bill 52 from federal

A

Allows voluntary euthanasia but not PAS
Must be at end of life, not forseeable death
Emphasis on suffering verified by clinician
Not required to have a serious medical con.
No required time frame before death

74
Q

3 federal MAID issues

A

Mature minors
MAID just for mental illness
Advanced requests for MAID

75
Q

7 places PAS is legal

A

Netherlands, Belgium, Switzerland, Luxembourg, Montana, Oregon, Washington

76
Q

Death with dignity act 1998

A

Oregon. Must have palliative care assesment before PAS. Resulted in increased PC provisions

77
Q

4 factors leading to MAID request

A

Suffering
Gain control
No burden to family
Depression

78
Q

CHPCA

A

Does not view MAID as a part of EOLC. Respect patient right to choose but they choose not to participate

79
Q

7 CHPCA MAID reccomendations

A 
Policy makers be more informed
Increased public debate
Access to palliative care 
Knowledge and skills of HCPs
Patients and families are informed
Safeguards to protect the vulnerable
CHPCA to promote well-being
80
Q

Drugs used for euthanasia

A

Barbiturates induce coma

Muscle relaxants stop breathing

81
Q

Integral Palliative care

A

Views MAID as a valid option at the end

82
Q

3 things to avoid with legal PAS

A

Widening of criteria to other groups
Pressure on vulnerable pops
Allow killing to be accepted in society

83
Q

Bill C-277

A

Framework for high quality palliative care. MAID is not voluntary without access to high quality PC

84
Q

6 MOH duties under C-277

A 
Define palliative care
Identify PC training/education for HCP
Measures to support care givers
Collect research and data 
Facilitate consistent access to PC
Include home PC in Canada Health Act
85
Q

Euthanasia

A

Intentionally killing by administering drugs at competent request

86
Q

Physician Assisted Suicide

A

Intentionally helping to terminate life by prescribing drugs. Authority of action lies with patient

87
Q

NTD

A

Allow imminent death from underlying condition. Withdraw treatment

88
Q

Palliative sedation

A

Monitored use of drugs to alter awareness and reduce suffering

89
Q

% of EOLC complaints due to poor communication

A

50%

90
Q

Effects of good communication

A

Improved emotional health reduce symptoms and pain, reduce need for drugs

91
Q

Calgary Cambridge Model

A 
Structure a consultation to make effective use of time and build rapport.
Initiate session
Gather info
Physical exam
Explanation/Planning
Close session
92
Q

Bad news

A

Gap between patient expectations and medical reality

93
Q

SPIKES strategy for breaking bad news

A 
Setting
Perception
Invitation
Knowledge
Empathy
Strategy/Summary
94
Q

How to deal with strong emtotion

A

Recognize and legitimize

Gain perspective, gather info and convey empathy

95
Q

PREPARED strategy for end of life discussions

A 
Prepare
Relate
Elicit
Provide
Realistic
Encourage
Document
96
Q

Collusion

A

Illegal conspiracy to deceive others. May occur when family requests to withhold info

97
Q

Deal with collusion

A

Clarify reasons, identify costs, propose a little info and negotiate a plan

98
Q

Denial

A

Unconscious mechanism to negate threat of integrity to personhood. Can reduce distress but may impede access to care

99
Q

People likely to be in denial

A

Low IQ
Sensory impairment
Incorrect information

100
Q

Spirituality

A

Assess
Listen
Respond
Teamwork

101
Q

Canadian institute for health research

A

Doubled the Pc publications between 2004-9, 8% world share of health reserach publications

102
Q

% of patients who discussed prognosis with doctor

A

18%

103
Q

$ funding by CIHR

A

4 million/year in PC reserach

104
Q

4 reasons why PC doesnt fit the EBM framework

A

Need a large sample for adequate power
Barriers in recruitment
Low attrition rate
Same treatment for wide variety of symptoms–> poor validity

105
Q

3 reasons to participate in study

A

Utility
Validation
Assurance

106
Q

Belmont Report 1979

A

Rules on research ethics
Respect for persons–> autonomy, safeguards
Beneficience–> study risks/benefits
Justice–> fair distribution of risk and benefit, participant selection

107
Q

4 alternatives to RCT

A

Good quality observational study
Collaborative research networks
Standardized data collection
Mixed methods and creativity

Palliative and EOLC (2 decks)

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