Integrative Symptom Management - Lauer

Question 1

What are the benefits and risks of pharmacologic symptom managment?

Answer 1

• Benefit
  
  • —Potentially effective
  • Evidence-informed
  • Placebo effect
• Risks
  
  • —Potential delay if ineffective
  • Side effects
  • Interactions
  • Pill burden
  • Cost

Question 2

What are the risks and benefits of non-pharmacological symptoms management?

Answer 2

• Benefits
  
  • Potentially effective
  • —Less likelihood of side effects
  • —Decreased pill burden
  • —Placebo effect
• ​Risks
  
  • —Potential delay if ineffective
  • Cost
  • Less evidence

Question 3

What is the Placebo Effect?

Answer 3

• Response to a biologically inert treatment
  
  • sugar pills
• —35-70% people will respond to biologically inert treatments
• —Negative connotations
  
  • crazy person
• —“Acupuncture does not decrease pain more than placebo.”

Question 4

Why should we avoid using the term “Placebo Effect”?

Answer 4

• 100% people will respond to the context and meaning of treatment
• —“Acupuncture decreases pain more than routine care/no treatment”
• —“…And so does sham acupuncture!”
  
  • better than doing nothing
• —Enhance this effect!

Question 5

What are the five main symptoms at the end of life?

Answer 5

• Dementia/Delirium
• —Shortness of Breath
• —Swelling
• —Anxiety
• —Nausea/Vomiting

Question 6

What is the difference between Dementia vs. Delirium?

Answer 6

• Dementia
  
  • Chronic loss of memory and other cognitive function
• —Delirium
  
  • Acute confusion, agitation, altered mental status

Question 7

What is the best environment, treatment, and approach for patients with dementia/delirium?

Answer 7

• Consistency
• —Lights on during day/lights off at night
• —Orientation cues
• —Animal assisted therapy
• —Music therapy
• Touch (warm blankets, rice bags, essential oils)
• Suspension of disbelief
  
  • don’t correct delusion
• Unconditional positive regard
• Understanding of limitations
• Eliminate polypharmacy
• Avoid Beers list
• Antipsychotics may help
  
  • avoid benzos

Question 8

What is dyspnea?

Answer 8

• —Dyspnea = shortness of breath
• Subjective feeling of being unable to catch breath
• Air hunger
• Tachypnea - breathing too fast
• Hypoxia - low oxygen level

Question 9

What is a helpful environment for patients with shortness of breath?

Answer 9

• —Cooler temperatures
• Open windows
• Fan/blow by oxygen (no consistent benefit)
• High ceilings
• Music therapy

Question 10

How do you manage mucous in patients with shortness of breath?

Answer 10

• Hydration
• Saline nebulizers
• Guaifenesin

Question 11

How do you treat/manage shortness of breath?

Answer 11

• Opiates
• —Treat the anxiety
• —Inhalers
• —Disease-modifying medications
• Oxygen
  
  • —Nasal cannula
  • —Mask
  • —Blow by
• —CPAP/BiPAP
• —Ventilation

Question 12

What are the causes/types of swelling?

Answer 12

• —Organ failure
• —Malnutrition
• —Physical obstruction
• —Dependent edema (fluid in legs/feet due to heart failure)
• —Ascites (fluid in retroperitoneal due to liver failure)
• —Anasarca (full body edema related to kidney failure)
• —Lymphedema (blockage by tumor)

Question 13

How do you manage swelling?

Answer 13

• Lymphedema massage
• —Percutaneous drainage
• —Horse chestnut
• —TEDs/tubigrips
• —Elevation
• —Diuretics