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hospice > Hospice General > Flashcards

Hospice General Flashcards

1
Q

FAST score 1

A

No difficulty subjectively or objectively

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2
Q

Caution in deprescribing anticoagulation in patients with

A

**mechanical mital valve
**left ventricular assist device
Mechanical aortic valve has some clotting potential but not as severe as in mitral valve

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3
Q

CYP 450 3A4 inhibitors, examples

A

Ketoconazole
Erythromycin
Diltiazem ( cardizem)
Grapefruit juice

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4
Q

Cyp350 3a4 inhibitors, affect on fentanyl

A

Reduce fentanyl metabolism, thus increase serum fentanyl level

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5
Q

New agitation/eestlessness, assess for…

A

Urinary obstruction
Constipation
Pain
Withdrawals
Med side effects

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6
Q

Medicare part A

A

-hospital insurance
-covers those age 65 and up, certain disabilities
-covers dialysis, hospice, hospital, rehab, SNF, rural health centers

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7
Q

Medicare part B

A
  • medical insurance for ages 66 and up, certain disabilities
    -Pay premium or copay for care
    -Covers professional services, ie: phhysician, NP, rehab, psychologist, psychiatrist.
    -Covers DME, home health, outpatient care
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8
Q

Balanced budget act of 1997

A

-Removed some restrictions, allowed APRN to bill independently
-set ARPN reimbursement rate at 85% of physician rate

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9
Q

Medicare modernization act (MMA) of 2003

A

among other things,
-NP able to serve as attending in palliative care for hospice and non hospice patients
-For hospice, NP cant certify terminal illness.
-Cant serve as hospice medical director or replace physician for IDT
-Cant bill unless serving as attending physician NP
-No NP can certify terminal illness or 6 month prognosis admission to hospice care
-CMS requires APRN to work in collaboration with a physician

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10
Q

4 fundamental ethical principles in palliative care

A

Autonomy
beneficence
non maleficence
justice

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11
Q

Additional ethical principles:

A

Honesty
trust
confidentiality
informed consent
principle of double effect

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12
Q

Decision making capacity

A

-Pt can make and communicate a decision
-Pt able to articulate understanding of
>medical situation and prognosis
>recommended care
>alternatives
>risks, benefits, consequences
-Pt uses reasoning to make a choice
-Decisions are consistent with pts values and goals

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13
Q

bioethical and legal expert consensus is there is no difference between deciding not to start a treatment and deciding to stop a treatment.

A

IE: just because it is started, doesnt obligate you to continue it

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14
Q

bioethical and legal expert consensus is there is no difference between deciding not to start a treatment and deciding to stop a treatment.

A

IE: just because it is started, doesnt obligate you to continue it

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15
Q

Palliative sedation

A

-intentional administration of sedatives to reduce a terminal patients consciousness to adequately controll refractory symptoms.
-Intent is to promote comfort and minimize distress

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16
Q

multiple myeloma: CRAB

A

Calcium elevation
Renal insufficiency ( creatinine elevated)
Anemia ( often normocytic, normochromic)
Bone pain (Lytic lesions, usually central skeleton, pain worse with movement)

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17
Q

Imodium
vs
Lomotil

A

Imodium ( loperamide hydrochloride)

Lomotil (diphenoxylate and atropine) – more side effects, on beers list

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18
Q

code status

A

only 8.4% survival to hospital discharge

Your illness is in its last stages. i understand that your quality of life is most important to you right now. With this in mind we want to focus on therapies that help you meet your goals. Resuscitation is unlikely to do this. Do you agree?

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19
Q

nociceptive pain

A

Activation of nociceptive (pain sensitive) structures)
-somatic pain
-visceral pain

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20
Q

Somatic pain

A
  • from cutaneous amd deep musculoskeletal tissues
    -ie: bone mets, incisional pain, myofacial or musculoskeletal inflammation or spasm
21
Q

Visceral pain

A

-infiltration, stretching, compression, distention of thoracic or abdomenal viscera
-ie: cirrhiosis, pancreatic cancer
-often “deep, knawing, squeezing or cramping” may be associated with n/v, diaphoresis.

22
Q

NSAIDs
Mechanism of action

A

-Inhibit enzyme cyclooxygenase
-Decrease prostaglandin production that protects gastric mucosa and renal parenchyma.

23
Q

NSAID contraindications

A

Chronic heart failure
Cirrhosis
Gastric bleed/ PUD
Significant atherosclerotic disease/HTN
multiple myeloma
renal failure
corticosteroids

24
Q

morphine to methadone ratio

A

<60mg morphine: refer to opioid naiive dosing
60-199mg MME, pt <65 yo. 10:1
>200mg MME and/or >65 y.o. 20:1

25
Q

Inotropes

A

Change force of heart’s contraction
posisitve inotropes= more force (dobutamine, digoxin)
negative inotropes= less force

26
Q

Intraparenchymal hemorrhages

A

are generally non traumatic
usually in context of HTN or cerebral amyloid angioplasty ( seen in Alzheimer’s)

27
Q

Dyspnea treatment

A

Treat underlying cause
morphine and fentanyl most commonly used for terminal dyspnea

28
Q

Cachexia

A

-Weight loss associated with muscle, with or without loss of fat mass.
-Chronic inflammation, metabolism, and neural hormonal factors play a part.
-Rarely reversed by supplements or increased nutritional intake.

29
Q

Classification criteria for cancer related cachexia

A

-involuntary weight loss of > 5kg in 6 months
-food intake < 1500kcal/day
-C reactive protein >10mg/dL

30
Q

Anthropomorphic measures of cachexia

A

-MAC
in men, <32cm
in women, < 18cm

31
Q

sarcopenia

A

loss of muscle mass
loss of strength
loss of function

32
Q

secondary cachexia

A

other etiologies for weight loss
-pain, n/v, anorexia, bowel obstruction, stomatitis, dysphagia, depression

33
Q

secondary cachexia

A

other etiologies for weight loss
-pain, n/v, anorexia, bowel obstruction, stomatitis, dysphagia, depression

34
Q

pharmacologic treatment for anorexia/ cachexia

A

-Progestins (megastrol, medroxyprogesterone acetate)
-corticosteroids
-cannabis and cannabinoids
-non specific agents (mirtazapine, olanzapine, melatonin)

35
Q

Laxative of choice in ESRD and de compensated cirrhosis

A

Lactulose

36
Q

FAST score 2

A

Complains of forgetting locations of objects
Subjective work difficulties

37
Q

FAST score 3

A

Decreased functioning evident to coworkers
Difficulty with traveling to new places
Decreased organizational capacity

38
Q

FAST score 5

A

Requires assist with choosing appropriate clothing for weather, location, day

39
Q

FAST score 6

A

occasionally or frequently:
A) improperly putting on clothing without help or cueing
B Unable to bathe properly
C) Unable to manage mechanics of toileting
D) Urinary incontinence
E) fecal incontinence

40
Q

FAST score 7A

A

Less than 6 intelligible words in a day or interview

41
Q

FAST score 7B

A

Single word in a day or extensive interview

42
Q

Fast Score 7C

A

Ambulatory ability lost

43
Q

FAST score7D

A

Cant sit up without assist

44
Q

FAST score 7E

A

Loss of ability to smile

45
Q

FAST score 7F

A

Unable to hold up head independently

46
Q

PPS 70%

A

Reduced ambulation
cant do Normal work/some disease
full self care
normal or reduced intake
full LOC

47
Q

PPS 80%

A

Full ambulation
normal level of acitivity with some effort/some disease
full self care
normal or reduced intake
full LOC

48
Q

PPS 90%

A

Full ambulation
Normal level of acitivity/some disease
Full self care
Normal intake
Full LOC

49
Q

PPS 60%

A

hospice (3 decks)

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