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Palliative Care > General palliative care > Flashcards

General palliative care Flashcards

1
Q

Prognosis and predicting factors in glioblastoma multiforme

A

Median survival 10-12mo

Survival <6mo:
- Karnofsky performance status <90
- Age >55
- tumor volume >50 cubic cm before resection
- recurrent dz
- mass in critical hemispheric brain region
- Hgb<12
- Plt >ULN

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2
Q

Prognosis in ARDS

A

40-50% mortality

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3
Q

Prognosis in sepsis with AKI

A

35% mortality

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4
Q

Signs of poor prognosis in colon cancer

A

Location- right sided
Signet rind, poorly differentiated and undiff
KRAS gene mutation
High preop CEA levels

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5
Q

30 day mortality after STEMI

A

2.5-10%

(NSTEMI has worse longer term outcomes)

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6
Q

Scale to assess performance status in adults

A

Palliative performance scale
OR
Karnofsky performance status scale

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7
Q

Scale to assess functional status in childern

A

Lansky score

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8
Q

Score to assess symptom intensity

A

Edmonton symptom assessment (ESAS)
OR
Memorial symptom assessment scale (MSAS)

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9
Q

Timing for diagnosis of complicated grief

A

requires 12mo since death of someone close to them

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10
Q

Characteristics of complicated grief

A

maladaptive thoughts, dysfunctional behaviors, dysregulated emotions, serious psychosocial problems that impede adaptation to loss.

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11
Q

Contraindications to organ donation

A

active heme malignancy
active melanoma
hx of creutzfeldt-jakob dz

HIV + can only go to HIV+ pts

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12
Q

Sx tx in ESRD: Agitation

A

Haldol 1mg q12h

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13
Q

Sx tx in ESRD: Anorexia

A

Tx: gastroparesis, depression, dry mouth. Appetite stimulants do not increase QoL

Dronabinol
megestrol
Prednisone 10mg daily

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14
Q

Sx tx in ESRD: Dyspnea

A

Hydromorphone 1mg PO q4h
Morphine (only if actively dying)
Fentanyl (acute care setting and short duration of action)

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15
Q

Sx tx in ESRD: Fatigue

A

Causes: Anemia, depression, malnutrition, meds, dialysis associated

Epo for anemia
fluoxetine 20mg daily
sertraline

NO TCA

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16
Q

Sx tx in ESRD: n/v

A

Causes: uremia, gastroparesis

Zofran 4mg q8h
metoclopramide
haldol for refractory n/v

17
Q

Sx tx in ESRD: pruritis

A

Cause: ?? uremia, 2dary hyperPTH, hyper phos, IDA

Nonpharm: emollients, UVB phototherapy

pharm: Hydroxyzine 25mg q6h
Zofran
Naltrexone
adjusted dose gabapentin
sertraline
capsaicin cream QID

18
Q

Sx tx in ESRD: restless leg syndrome

A

Treat iron deficiency
Ropinirole
Pramioexole

19
Q

Sx tx in ESRD: sleep disturbance

A

Temazepam 15mg PO qhs
zolpidem 5mg PO qhs

20
Q

When is there no survival benefit for dialysis patients?

A

older than 80yo
older than 70 with comorbidities

21
Q

5 yr survival for pts on HD

A

40.2%

22
Q

5 year survival for pts on PD

A

50%

23
Q

5 yr survival in pt with ESRD >75 yo

A

17%

24
Q

Mean survival after discontinuation of dialysis

A

7.4 days

25
Q

predictors of shorter survival after discontinuation of dialysis

A

worse functional status (PPS 10-20)
initial site of care inpt hospice or hospital
nonwhite
peripheral edema

26
Q

Classification in HF

A

NYHA (I-IV) function
- can change with symptoms
- Correlates with hospital use and life expectancy

AHA- (A-D) progression and sx
- Can not go backwards
- A: no disease but at risk
- B: no dz but structural dz
- C: clinical HF with structural dx + sx
- D: refractory HF

27
Q

Prognostic models for HF

A

Seattle HF model (only HFrEF)
HF Survival Score (used for transplant pts)

28
Q

Factors used for seattle HF model

A

NYAH class
EF
ischemic etiology
low SBP
sodium levels

29
Q

HF survival score factors

A

Peak O2 uptake or 6MWT

30
Q

Contraindications for LVAD

A

active malignancy or infection
active substance use
severe RV dysfunction
HD
cirrhosis
insufficient social support
inability to take AC

31
Q

When to stop warfarin

A
  • high risk of fall
  • dietary intake drops 50% or more, or eating is erratic
  • Liver failure
  • no longer checking INR
  • Bleeding
32
Q

frame work for deprescribing (Holmes model)

A

4 factors:
1. goals of care
2. prognosis
3. treatment target (primary prevention vs. secondary)
4. time-until-benefit

33
Q

Antimicrobial therapy at then end of life

A
  • no symptomatic relief in dying pts (depended on type of infection, UTI and otitis media better)
  • Little evidence that there is survival benefit if prognosis is weeks to months. (if longer then worth treating)
  • Can treat symptoms of infection without antibiotics
34
Q

Potential harms of antibiotics at the end of life

A
  • Adverse effects (diarrhea, seizures)
  • burden of taking meds
  • Cost

Palliative Care (11 decks)

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