JuneBehavioral Flashcards
4 Modifiable Health Risks
lack of physical activity, poor nutrition, tobacco use, excessive alcohol
6 Chronic Diseases
CAD, Cancer, Respiratory from Smoking, Arthritis, Obesity
CCM
Care Coordination Model
Use of non-physician team members, onhancement of info systesm, planned encounters and care managemen for high risk patients are examples of which model?
CCM
Patient that is motivated, has the pertinent infomration and condfidence to make decisions about their health is called this.
Informed Activated Patient
A patient that is able to use and interpret health informatino , manage own illness, is attentive to preventative care, recognizes early sx and knows where to get help is called this
Health literate patient
A group that has patient info, decision that are backed up and resources are called this.
Prepared practive team
Describe productive interaction
Protocols mold management, collaborative goal setting, active follow-up
Cornerstone of self-management support
Emphasize patient role as most responsible
Changes to the delivery of healthcare system design include
Define roles/task, planned interactions (visits with agenda), case management for high risk pt., follow up, make sure pt. understand
A health visit that has an agenda is called this.
Planned interactions
Advantages of care coordination
Less delays or miscommunication, less waste, more rewarding
When is case management used
For high risk pt. Help PCP keep check on pt.
When evidence based guideline and specialist expertise are integrated int primary care it is called this.
Decision support
Identification of subpopulations that could beneift from proactive care is an example of this system.
Clinical Information Systems
Identification of subpopulatinos that could beneift from proactive care is an example of this system.
Clinical Information Systems
4 modifiable helath risks
lack of physical activity, poor nutrition, tobacco use, excessive alcohol
Describe quality care
Pt. centered, scientifically based, population outcome based, refined individualized, compationable with resources and policies
Organization philosophy empasizes Quality Improvement (QI)
Best practice
Determining what works in specific pt. population through outcome research
Evidence based Practice
% of participants who show improvement long term
Efficacy
Particiption times efficacy
Impact
Ability to make his/her own decision
autonomy
6 chronic diseases
CAD, Cancer, Respiratory from smoking, Arthritis, Obesity
do no harm
Benefience
CCM
Care Coordination Model
possibility that the best thing to do is nothing
non-maleficence
Use of non-physician team members, onhancement of info systesm, planned encounters and care managemen for high risk patients are examples of which model?
CCM
concept of moral rightness
justice
Patient that is motivated, has the pertinent infomration and candfidence to make decisions about their health is called this.
Informed Activated Patient
Describe situation of decreasing autonomy
Disability is increasing, competency in question
A patient that is able to use and interpret health informatino , manage own illness, is attentive to preventative care, recognizes early sx and knows where to get help is called this
Health literate patient
Surrogate needs to keep best in mind
susbstituted judgement
A group that has patient info, decision that are backed up and resources are called this.
Prepared practive team
Unintened effect of an action
double effect
Describe productive interaction
Protocols mold management, collaborative goal setting, active follow-up
Defines quality of life
personal values, beliefs, priorities
Cornerstone of Self-management support
Emphasize patient role as most responsible
Goal of palliative care
sx management and QOL
Changes to the delivery of healthcare system design include
Define roles/task, planned interactions (visits with agenda), case management for high risk pt., follow up, make sure pt. understand
POLST
Physician Ordered Life Saving Treatment
A helath visit that has an agenda is called this.
Planned interactions
Temporary reason for anorexia
recovering from surgery
Advantages of care coordination
Less delays or miscommunication, less waste, more rewarding
States where PAS is legal
OR, WA, MT, VT
When is case management used
For high risk pt. Help PCP keep check on pt.
Plan of care that focuses on quality of life rather than extending life by any means
Hospice
When evidence based guideline and specialis expertise are integrated int primary care it is called this
Decision support
Percent of Hospice patients with cancer
40%
Identification of subpopulatinos that could beneift from proactive care is an example of this system.
Clinical Information Systems
Common hospice chronic diseases
CAD, pulmonary disease, dementia, renal disease, stroke, ALS
Describe quality care
Pt. centered, scientifically based, population outcome based, refined individualized, compationable with resources and policies
Things to consider besides disease of hospice patient
prognosis, age, frailty
Organization philosophy empasizes Quality Improvement (QI)
Best practice
Reasons for early hospice referral
Allow relationship to form, better QOL, better chance of staying home
Determining what works in specific pt. population through outcome research
Evidence based Practice
Contraindications to hospice referral
Actively dying patints and patients who want aggressive care
% of participants who show improvement long term
Efficacy
1 symptoms of hospice patient
pain
Particiption times efficacy
Impact
Problem of prognosis given by Drs.
overly optimistic
Ability to make his/her own decision
autonomy
3 aspects of reserve irt to living with terminal illness
age, frailty, stress
do no harm
Benefience
Loss of ability to use nutritions cause this.
Loss of appetite
possibility that the best thing to do is nothing
non-maleficence
Anorexia/Cachexia syndrome
Loss of appetite and muscle wasting
concept of moral rightness
justice
Tipping point before dying, usually 1-2 weeks before
Transitioning
Describe situation of decreasing autonomy
Disability is increasing, competency in question
First area to be cut off while actively dying
lower extremities
Surrogate needs to keep best in mind
susbstituted judgement
inability to manage own secretions
death rattle
Unintened effect of an action
double effect
Breath pattern aftern stroke or active brain tumor
Cheyne-Stokes respirations
Defines quality of life
personal values, beliefs, priorities
Respiration pattern from cerebral ischemia
agonal respiration
Goal of palliative care
sx management and QOL
Area of brain affected in death first
Frontal center
POLST
Physician Ordered Life Saving Treatment
Brains shuts down in this area
Front to back
Temporary reason for anorexia
recovering from surgery
States where PAS is legal
OR, WA, MT, VT
Plan of care that focuses on quality of life rather than extending life by any means
Hospice
Percent of Hospice patients with cancer
40%
Common hospice chronic diseases
CAD, pulmonary disease, dementia, renal disease, stroke, ALS
Things to consider besides disease of hospice patient
prognosis, age, frailty
Reasons for early hospice referral
Allow relationship to form, better QOL, better chance of staying home
Contraindications to hospice referral
Actively dying patints and patients who want aggressive care
1 symptoms of hospice patient
pain
Problem of prognosis given by Drs.
overly optimistic
3 aspects of reserve irt to living with terminal illness
age, frailty, stress
Loss of ability to use nutritions cause this.
Loss of appetite
Anorexia/Cachexia syndrome
Loss of appetite and muscle wasting
Tipping point before dying, usually 1-2 weeks before
Transitioning
First area to be cut off while actively dying
lower extremities
inability to manage own secretions
death rattle
Breath pattern aftern stroke or active brain tumor
Cheyne-Stokes respirations
Respiration pattern from cerebral ischemia
agonal respiration
Area of brain affected in death first
Frontal center
Brains shuts down in this area
Front to back
Pain Evaluation - LOCATES
Location, Other sx, Chraacter of pain, Aggravating factor, Timing, Enviroment where pain occurs, Severity of pain
Four componets of total pain
PAIN - Physical pain, Anxiety, Interpersonal Interactions, Nonacceptance
No baseline pain treatment?
Short acting tx
Baseline pain tx
Long acting tx
Baseline pain + breakthrough pain
long acting + short acting pain
Tramadol pro drug of?
Morphine
Oxyocodone prodrug of?
Dilaudid
Dosing equivalent to enteral
oral, buccal, sublingual, rectal
parentral equivalent
IV, subcutanous, transdermal, intramuscular
Enteral opiates peak time
1 hour
Parental Iv peak
8 minutes
Parental subcutanous peak
30 minutes
Methadone
start low, go slow - very long half life
Things to consider with opiate dosing by estimate
age, disease, tolerance
Morphine Iv dose –> Morphine oral
3 times
Duladid(hydromorphone) IV –> Duladid Oral
4 times
Duladid Oral –> Morphine Oral
5 times
Concern Methadone
Long QT syndrome (above 30 mg/day)
Methadone half life
4 days
Biggest side effect of Opiates
Constipation
Most important skill to becoming good Dr
Active listening
Location of neurons that cause emesis
medulla
Input that disrupt cortex and causes vomiting
ICP/anxiety
Input that disrupts vestibular
motion or vestibular disease
input that bothers chemoreceptor trigger zone
NT as no BBB
Input that triggers nausea in peripheral pathway
Gi tract and vagus nerve
Drug for chemo nausea
Zofran - 5 HT3 antagonist
Drug for opiod nausea
Reglan, compazin, haldol - D2 antagonist
Drug for vestibular nausea
scopolamine - muscarinci Ach
5 classes of treatment for constipation
stool softener, bulk foriming agents, osmoitic agents, lubricant, stimulant laxative
stool softener
docustae
bulk forming agents
absorb water - methylcellulose
osmotic agents
miralax (sorbitol)
lubrincant
mineral oil
stimulant laxative
senns
Drugs that cause dyspnea
opiods, benzodiazepines, bronchodilators, duretic
delerium differs from dementia
more acute, more flucuating,
Reason for increased pain in delerium
loss of disinhibition
Dyspnea treatment medication
Haldol
Dyspnea treatments
antibiotics, O2, Meds, Fluids
Anticipating, preventing and treating suffering
Def. of palliative care
Reason for palliative sedation
sedate so they are not aware of pain/suffering
Palliative sedation restrictions
less than 2 weeks to live
Defintion of intolerable
opinion of patient
