Lecture #11 - Sx Management

Question 1

CARES acronym stands for (nurse driven)? Provides?

Answer 1

• Comfort
• Airways: management of dyspnea. Oral suctioning ineffective, b/c rapidly re accumulate and increase agitation. Morphine is recommended standard for treat. of shortness of breath. O2 supplementation is often ineffective in dying process, but reassures family.
• Restlessness and delirium
• Emotional and spiritual support
• Self-Care: for nurses mental health
• Sx-based care during the last days of life.

Question 2

Double-effect?

Answer 2

Intervention with benefits outweighing the negative risks. Intent is to relieve suffering and not euthanize pts.

Question 3

Common Sx in EOL?

Answer 3

pain, fatigue, cachexia, confusion, peripheral edema, skin ulcers, anxiety, depression, dyspnea, N/V, constipation/D

Question 4

Sx are under-reported? stats?

Answer 4

1/3 Sx experienced were self-reported

Question 5

What is total pain?

Answer 5

It is social, psychological, spiritual and physical pain.

Question 6

WHO five essential concept to drug therapy of pain?

Answer 6

1) Oral route is preferred for nociceptive/neuropathic pain.
2) For persistent pain, around-the-clock meds + PRN should be used.
3) Move up the ladder: non-opioid -> weak opioid -> strong opioids (codein to morphine) and not side-ways (morphine to oxycodone)
4) Dose varies from individuals. The RIGHT DOSE relives pain with fewer SE.
5) Other factors need to be addressed (spiritual, psychological, etc) in addtition to pharma

Question 7

Pain management four step process?

Answer 7

1) Assessment
2) Weigh benefit/burdens of each treatment
3) Manage pain with individualized specific interventions
4) Continuously reassess treatment goal

Question 8

Pain assessment?

Answer 8

pain history, believing pt, numeric pain scale and what are the functional goals?

Question 9

Physical sign pt is in pain?

Answer 9

grimacing, furrowed brows, restlessness, moaning, tears

Question 10

unconscious pt experience pain?

Answer 10

YES

Question 11

Why does breakthrough pain (spike) occurs?

Answer 11

End of dose
Incidental (happens with specific activities)
Idiopathic (true breakthrough pain

Question 12

Breakthrough doses?

Answer 12

same molecules

10% of daily opioid regularly given q1h PRN

Question 13

Adjuvant drugs?

Answer 13

Non-opioid that enhance analgesia

Question 14

Adjuvant drugs for bone pain?

Answer 14

NSAIDS, steroids, bisphosphonates

Question 15

Adjuvant drugs for neuropathic pain?

Answer 15

TCA, gabapentin, cortico

Question 16

Opioid neurotoxicity?

Answer 16

Renal failure

Sx: hyperalgia, myoclonus, delirium, convulsions

Question 17

If pt doesn’t achieive pain control with opioid by how much can you increase the doses?

Answer 17

25-50%

Question 18

When anorexia, does IV nutrition/hydration prolong life/well being in EOL?

Answer 18

NOt proven, but if not close to death, hydration will help.

Question 19

When not to hydrate?

Answer 19

Terminal hase
severe edema
prone to pulm. edema

Question 20

Change in resp patterns = dyspnea?

Answer 20

NO

Question 21

Can Rx alter resp. patterns?

Answer 21

NO

Question 22

Interventions in managing dyspnea?

Answer 22

• Reassurance
• 45-90degrees
• open windows
• fan
• relaxation
• avoid irritants

Question 23

Does morphine hasten death?

Answer 23

NO, when doses proportionate t degree of distress

Question 24

Supplemental O2 recommended to?

Answer 24

Hypoxic pt experiencing dyspnea. But if not hypoxic, it is not recommended.

Question 25

Dyspnea management generally focuses on?

Answer 25

Comfort and not oximetry

Question 26

When to consider suctioning?

Answer 26

If secretion proximal and pt not responding to anti secretory agents.

Question 27

What is PPS scale?

Answer 27

Palliative Performance Scale

Question 28

Management of fatigue?

Answer 28

Treat cause if possible. (Eg. anemia = blood)