Hospice Flashcards
What to tell families about how long hospice live compared to those who don’t use hospice benefit?
A 2007 survey of more than 4000 Medicare patients revealed that no patients receiving hospice care died sooner than patients with similar conditions not under hospice care. Patients with heart failure who received hospice care lived an average of 81 days longer than those not receiving hospice care.
Medicare admit criteria for Heart Failure Patient?
Medicare admission criteria for patients with heart failure include an ejection fraction of <20% as one important criterion, but this is not required. Other criteria supporting hospice eligibility for patients with heart disease include the following:
Identification of specific structural or functional impairments
A poor response to diuretics and vasodilators
Dyspnea or tightness in the chest
Chest pain
Impairment of heart rhythms, contraction force of ventricular muscles, or blood supply to the heart
Changes in appetite or unintentional weight loss
Impaired sleep functions
Decline in general physical endurance
Relevant activity limitations or impaired mobility
Some pearls about estimating longevity
Physicians tend to overestimate longevity. In one study, physicians overestimated longevity by a factor of 5.3.
Physician accuracy in prognosis improves with experience but declines the longer the physician has known the patient. While estimating a prognosis is inherently imprecise, many patients and families feel that it adds value.
How can morphine and lorazepam help with terminal breathlessness in hospice pt.
Regular dosing of an opioid has been shown to improve comfort and exertional tolerance in patients experiencing continuous breathlessness from illness without increasing mortality. Lorazepam reduces the anxiety associated with breathlessness but does not target the dyspnea.
How to treat and what is prognosis of malignant pleural effusion?
A malignant pleural effusion is generally a poor prognostic sign, associated with an average survival of 4–6 months. These effusions can cause significant issues with quality of life, especially reduced exercise tolerance and symptomatic dyspnea. Systemic chemotherapy or hormonal therapy is the best way to improve symptoms if that is still an option for the patient. A variety of options exist for management of the pleural effusion, and a multidisciplinary team of interventional radiology, surgery, pulmonology, and oncology professionals should be considered. If the prognosis is for short-term survival, repeated thoracentesis for comfort may be an option. Tunneled pleural catheters were found in a 2012 cost analysis to be the most cost-effective treatment strategy when the prognosis was for survival of 3 months or less, with symptom improvement in 96% of patients. Fluid re-accumulation is common when thoracentesis or chest tube drainage alone is used.
Severe Small bowel obstruction can be treated with what?
Octreotide has been used in malignant small bowel obstruction to decrease peristaltic activity and fluid retention. It appears to bring symptomatic relief in 60%–90% of patients
Some facts on the death process and the effects certain meds have on it?
Fluids
Opioids
Lorazepam
Oxygen
The natural dying process is usually fairly painless. Multiple organs slow their function, and cardiac arrest follows shortly after respirations finally stop. Supplemental fluids abort the central production of endorphins, increase patient discomfort, and may cause dyspnea if pulmonary edema develops. Opioids have been well studied across groups and have not been correlated with hastened death at carefully titrated doses. It may be that while death sometimes appears to immediately follow administration of an opioid, at other times death may be delayed by their beneficial effects, resulting in a null effect on average. Family members may be reassured by this information and an explanation that the disease led to the patient’s death, not the medicine. Lorazepam is often used with an opioid at the end of life to decrease anxiety and potentiate the opioid. Routine supplemental oxygen is not associated with increased comfort or longevity.
Validated way to treat cancer related fatigue?
Treating cancer-related fatigue is a well established off-label use for methylphenidate. It is important to identify and treat other possible causes of fatigue, such as severe anemia, depression, or infection
What is hypodermalclysis and how is it delivered?
Hypodermoclysis (HDC) is subcutaneous fluid infusion, a form of parenteral hydration. Using fluids in palliative care patients can be controversial. If fluids are given, hypodermoclysis is a way to provide parenteral hydration without pain or special expertise. In fact, family members can be trained to insert the infusion catheter. Only about 1.5–3.0 L/day can be given by HDC and the preferred solution is one with electrolytes, not plain dextrose, as there is usually more edema with electrolyte-free solutions such as D5W. HDC catheters can be placed in the arm, back, abdomen, and/or thigh. Parenteral hydration is not a requirement for admitting a palliative care patient to the hospital.
What is OIP?
opioid induced pruritis. Usually only with intrathecal opioid administration. Either switch, or use anti histamines. zofran can also help.
