Integrative Symptom Management

Question 1

What percentage of people will respond to a placebo?

Answer 1

35-70%!

Question 2

WHy shouodn’t you use the word placebo?

Answer 2

Because it still works! Who cares how it works

Question 3

What are some factors that will influence the placebo affect and how well it works?

Answer 3

color of the pills, number of the pills, labeling (branding), route of administering (IV is better), setting of treatment (hospital is better), beliefs around treatment (if they think it will work it probably will)

Question 4

Describe the healign power of intention.

Answer 4

we as doctors will influence whether a treatment will work

if we authoritatively believe it will work, it’s mroe likely to work - so spend more time and be positive

Question 5

What’s the difference between dementia and delirium?

Answer 5

dementia is chronic, delirium is acute

both are common at the end of life

Question 6

What are some environmental ways to help delierium?

Answer 6

maintain consistency
give light cues as to daytime
orientation cues
aniaml assisted therapy
music therapy

Question 7

What are some touch ways we can help delierium?

Answer 7

warm blankets

weight - rice bags, lap bags, weighted blankets

Question 8

How should you approach someone with dementia?

Answer 8

suspension of disbelief
unconditional positive regard
understanding of limitations

Question 9

What are some environmental ways we can improve SOB?

Answer 9

cooler temps
open windows
blow by oxygen
high ceilings
music therapy

Question 10

What are the ways we can improve the hypoxia with the SOB?

Answer 10

oxygen via blow by > cannula > mask

CPAP, BiPAP, ventilation less ideal

Question 11

How can we help the mucus in SOB?

Answer 11

hydration, saline nebulizers, guafenesis

Question 12

What are some ways we can deal with swelling?

Answer 12

lymphedema massage, percutaneous drainage, horse chestnut, TEDs, elevation, diuretics

Question 13

What are some factors that can feed into anxiety at the end of life?

Answer 13

fear of death
adrenal tumors
acute air hunger
chronic dyspnea

Question 14

What are some strategies we can use to deal with breathin and reduce anxiety?

Answer 14

square breathing
guided imagery
heart math

Question 15

What’s anticipatory nausea

Answer 15

it’s brough on by familiar unpleasant triggers like foods that made us sick int he past - just thinking about them

Question 16

What are some treatments for xerostomia?

Answer 16

stop a drug if it's causing it
good mouth care
lemon or sour foods
artificial saliva
blycerin swabs
pilocarpine to increase muscarinic activity