Lecture 13 Cancer, pain, and end of life

Question 1

Continuum of care across the lifespan

Answer 1

1. As a person ages, there is a balance between curative care and palliative care.
2. Palliative care and eventually hospice care assume a greater focus toward the end of life.
3. Hospice care culminates with death, and is followed by bereavement care.

Question 2

Older adults and cancer

Answer 2

Older adults are disproportionately affected by cancer, less likely to be screened for cancer, and are diagnosed at a later stage.

Question 3

Wellness outcomes related to cancer can be promoted by teaching about _

Answer 3

1. Primary prevention interventions.

2. Screening recommendations.

Question 4

Regarding different ethnic groups, diabetes is especially prevalent among _

Answer 4

1. Native Americans and Alaskan Natives.
2. Blacks.
3. Hispanics.

Question 5

A leading cause of hospitalizations among older adults is _, and _ of admissions are potentially preventable with adequate self-care.

Answer 5

Heart failure; 57%.

Question 6

Nurses promote caregiver well-being by identifying and addressing issues related to _

Answer 6

Caregiver burden.

Question 7

_ pain is time-limited and responsive to analgesics.

Answer 7

Acute.

Question 8

_ pain continues for a prolonged period and may or may not be associated with a recognizable disease process.

Answer 8

Persistent.

Question 9

Process of pain conduction (nociception) in the body

Answer 9

1. Transduction of a noxious stimulus (tissue damage).
2. Transmission of action potentials from the site of damage to the brain.
3. Perception occurs when a person becomes conscious of pain.
4. Modulation is the body’s response to the painful stimuli.

Question 10

Somatic pain

Answer 10

Type of nociceptive pain localized from muscle, joints, skin, etc.

Question 11

Visceral pain

Answer 11

Type of nociceptive pain that arises from internal organs and is often referred.

Question 12

Neuropathic pain

Answer 12

Pain caused by damage or disease affecting the central nervous system and/or peripheral nervous system (e.g., shingles).

Question 13

Post-herpetic neuralgia

Answer 13

A form of neuropathic pain caused by nerve damage due to the varicella zoster virus.

Question 14

The most common cause of persistent pain in the older adult population is _

Answer 14

Arthritis (affects 49-59% of older adults).

Question 15

One of the most common barriers to pain management with the older adult population is _

Answer 15

An erroneous attitude that pain is a normal part of aging.

Question 16

Functional consequences of pain in the older adult include _

Answer 16

1. Diminished physical function.
2. Loss of mobility.
3. Higher levels of disability.
4. Decreased quality of life.

Question 17

Pain that goes untreated can lead to serious consequences, including _

Answer 17

1. Anxiety.
2. Depression.
3. Suicide.

Question 18

Opioid analgesics

Answer 18

1. Medications that relieve pain by binding to opioid receptors in the central nervous system.
2. Examples: Codeine, oxycodone, morphine, tramadol, fentanyl, methadone.

Question 19

Non-opioid analgesics

Answer 19

1. Medications that act at the site of the injury to decrease pain.
2. Examples: Acetaminophen, NSAIDs, aspirin.

Question 20

Adjuvant analgesics

Answer 20

1. Medications that have a primary indication other than the treatment of pain, but may help relieve pain due to their effects on the modulation phase.
2. Examples: Antidepressants and anticonvulsants.

Question 21

World Health Organization pain relief ladder

Answer 21

Step 1= Mild pain (1-3); treat with a non-opioid ± an adjuvant.
Step 2= Moderate pain (4-6); treat with an opioid for mild to moderate pain ± a non-opioid ± an adjuvant.
Step 3= Severe pain (7-10); treat with an opioid for moderate to severe pain ± a non-opioid ± an adjuvant.

Question 22

Older adults experiencing severe pain are likely to be prescribed _

Answer 22

Stronger opioids with a short half-life.

Question 23

Around-the-clock analgesia and breakthrough medications may be implemented for _

Answer 23

Moderate pain (and definitely for severe pain).

Question 24

Rapidly titratable analgesic medications are most likely to be used with _

Answer 24

Severe pain.

Question 25

The most common side effect of opioid administration is _, and it can be lessened through the use of _

Answer 25

Constipation; a prophylactic bowel regimen.

Question 26

Tolerance

Answer 26

1. A physiologic protective mechanism that helps the body become accustomed to a medication so that adverse effects (except for constipation) gradually diminish.
2. Characterized by a decrease in one or more therapeutic effects of the medication (e.g., less analgesia) or its adverse effects (e.g., nausea, sedation, or respiratory depression).

Question 27

Tolerance to analgesia usually occurs during the first _ to _ of therapy.

Answer 27

Several days to 2 weeks.

Question 28

Dependence

Answer 28

1. A normal physiologic response manifested by the development of withdrawal symptoms upon sudden discontinuation of a medication.
2. The best approach is to gradually reduce the dose of the medication, rather than abruptly discontinuing the drug.
3. Not necessarily an indicator of addiction; rather, it indicates that the drug is medically necessary for managing symptoms.

Question 29

Dependence is likely to occur when an opioid has been administered repeatedly for more than _

Answer 29

2 weeks.

Question 30

Addiction

Answer 30

1. A chronic disease with biologic, neurologic, and psychological characteristics related to a particular drug.
2. Marked by craving, compulsive use, inability to control use, and continued use even when harm occurs.
3. Rarely occurs in relation to analgesic medications; patients may need to be reassured that the risk is minimal.

Question 31

Tolerance and dependence are normal responses that should be expected when opioids are taken for _ to _ or longer.

Answer 31

2 to 4 weeks.

Question 32

_ of Americans age 65 and older die in hospitals, although more than _ state their desire to die at home.

Answer 32

50%; 70%.

Question 33

_ is a philosophy of care with the goal of supporting dignified dying and a good death experience for terminally ill patients and their families.

Answer 33

Hospice.

Question 34

End-of-life supportive interventions - presence

Answer 34

1. A “gift of self” in which the nurse is available and open to the situation.
2. Demonstrated through verbal communication, valuing what the patient says, accepting the patient’s meaning of things, and remembering or reflecting.

Question 35

End-of-life supportive interventions - compassion

Answer 35

The nurse strives to be totally and compassionately with the patient and their family, allowing the most positive experience.

Question 36

End-of-life supportive interventions - touch

Answer 36

1. A powerful therapeutic intervention, it communicates an offer of unconditional acceptance.
2. It can be both healing and life affirming, a means of communicating genuine care and compassion.

Question 37

End-of-life supportive interventions - recognition of autonomy

Answer 37

The nurse realizes and respects the individual’s right to make all end-of-life decisions.

Question 38

End-of-life supportive interventions - honesty

Answer 38

1. The nurse is often in a front-line position to communicate/explain what can be expected.
2. Builds trust with the older adult facing death and his or her family.

Question 39

End-of-life supportive interventions - expert communication

Answer 39

Nurses need to be able to assess the patient and family, implement a plan to comfort them, and communicate clearly and supportively throughout.

Question 40

End-of-life supportive interventions - assisting in transcendence

Answer 40

At the highest level of care, nurses provide emotional support that facilitates the experience of self-transcendence and a sense of triumph over death.

Question 41

Communicating with dying patients and their families - what to say

Answer 41

1. “What do you need me to do for you?”
2. “Is there anyone I can call for you?”
3. “I’m here to listen.”
4. “No need to rush. Take your time.”
5. “It’s okay to cry. Let me get you a tissue.”
6. “Would you like to be left alone?”
7. “Would you like to share some memories?”

Question 42

Communicating with dying patients and their families - what not to say

Answer 42

1. “She’s in a better place now.”
2. “He lived a full life.”
3. “She’s out of her pain.”
4. “It’ll be all right.”
5. “Don’t cry.”
6. “Be strong.”
7. “He’d want you to get on with your life.”

Question 43

The most popular pain intensity scales used with older adults are _

Answer 43

1. The Numeric Rating Scale (NRS) - 0-10 rating; most popular scale.
2. The Verbal Descriptor Scale (VDS) - ideal when cognitive impairment is present; patient describes their pain as “no pain,” “mild,” “moderate,” “severe,” or “pain as bad as it could be.”
3. The Faces Pain Scale-Revised (FPS-R) - best for use when language/communication barriers are present, but considered the weakest in terms of validity.

Question 44

When choosing which pain assessment scale to use, the most important consideration is _

Answer 44

The consistent use of the same scale with each individual patient.