Lecture 4: Psychological and Social Considerations of Pain + Death Flashcards
What are the 7 psychosocial consequences of pain and loss?
- fear and anxiety
- depression
- loneliness & anger
- caregiver burden
- bereavement
- financial and resource burden
- substance abuse
T/F: Anxiety is the unpleasant emotional response caused by anticipation or awareness of specific danger.
F: FEAR is the unpleasant emotional response caused by anticipation or awareness of specific danger
What does fear encourage?
Encourages avoidance from the threat
What is the result of the physiological response of “fight or flight”?
- dry mouth & “butterflies”
- palpitations & hyperventilation
- dizziness, tremor, sweating
- urinary urgency
What are two classifications of causes for Fear?
organic and non-organic
What are examples of organic causes for fear?
- pain
- steroids
- bronchodilators
- EtOH/hypnotic withdrawal
- cerebral irritation
- impending catastrophic event
What are examples of non-organic causes of fear?
Situation: -impending procedure -relapse -withdrawal -impending death -loss of autonomy Disease: -psychiatric -delirium -Generalized Anxiety Disorder -PTSD -Depression
T/F: Anxiety is prompted by generalized, non-specific threats to the ‘self’
True
T/F: anxiety motivates hypervigilance but does not motivate retention of proximity to the perceived threat
F: Anxiety motivates hypervigilance and retention of proximity to the perceived threat
What are 10 ways anxiety may manifest?
- Feeling, swamped, or overwhelmed
- Trouble thinking, solving problems, or making decisions (even about little things)
- Feeling agitated, irritable, restless, or panicked
- Feeling or looking tense
- Concern about “losing control”
- Uneasy sense that something bad is going to happen
- Trembling or shaking; headaches
- Being cranky or angry with others
- Trouble coping with tiredness, pain, nausea, and other symptoms
- Problems sleeping or restless sleep
What are three characteristics of a panic attack?
- discrete period of intense fear
- 4+ symptoms develop abruptly
- peaks within 10 minutes
Would it be considered a panic attack if it peaked over the course of an hour?
No, would peak within 10 minutes
T/F: terminal agitation is a distressing form of delirium in dying patients
True
What are the four physical causes of terminal agitation?
- opioid toxicity/withdrawal or drug interactions
- pain or raised ICP
- fever/sepsis/ hypercalcemia
- psychological elements
What are psychological and spiritual causes of terminal agitation?
- spiritual/emotional/physical restlessness
- anxiety/agitation/cognitive failure
T/F: Signs of terminal agitation as a cause of psychological, spiritual or emotional restlessness includes unintentional and purposeless motion without emotional distress?
FALSE: signs of spiritual, emotional, or psychological restlessness is signified by:
- unintentional and purposeless motion
- emotional distress and restlessness
T/F: Stress is not defined by mental or emotional strain, it is purely physically manifested?
False: stress is a state of mental or emotional strain or tension during demanding circumstances
What is Thanatophobia?
The fear of death
Why do patients develop PTSD?
PTSD as a result of fear of recurrence of illness
What are some examples of how you can remove reversible organic causes to manage fear and anxiety?
- drug reactions + withdrawal; providing coffee
- urinary tract infection: provide treatment to take away discomfort
- obstructive/central sleep apnea: sleep ap machine
- ‘sundowning’: providing medication/increased activity in the evening, encouraging elders to sleep earlier
- dehydration: reminders to drink water
T/F: cold water is a solution for management of acute fear and anxiety
True
What are 6 pharmaceutical solutions for different approaches for acute vs. chronic fear and anxiety?
- alcohol
- benzodiasepines
- beta-blockers
- barbiturates
- opioids
- antidepressants (SSRIs, TCA)
What are 7 different methods for non-pharmaceutical therapy and counseling to manage chronic fear and anxiety?
- Cognitive Behavioral Therapy
- Behavior Therapy
- Talk Therapy (individual or group, online forum)
- Psycho-Philosophical: Achieving Fearlessness
- Meditation, Yoga, Tai-Chi, Religious Observances, Music
- Hot Bath, Massage, Haircut/Shave, Grooming
- Foods & Herbal Remedies (chocolate, tryptophan, probiotics, folate & b vitamins)
T/F: Depression is properly treated in advanced illness because of it’s prevalence
False: Depression is often undertreated in advanced illness
What are some treatments that influence depression?
Chemotherapy and end-of-life medications such as steroids, narcotics, benzodiazepenes, antihistamines, antibiotics
What are three highlighting symptoms of depression to look out for?
- fatigue and loss of energy
- significant weight loss or gain
- insomnia or hypersomnia
T/F: sleep disturbance is NOT a contributing factor for cancer patients undergoing radiation and chemotherapy. Chemotherapy is the main cause of the depression symptoms.
FALSE: Chemotherapy and radiation treatment results in sleep disturbance, fatigue, anorexia and weight loss both with AND without depressive syndromes
T/F: Hypoactive delirium is commonly mistaken for depression
True
T/F: Treating hypoactive delirium with antidepressants would improve delirium symptoms?
FALSE: would exacerbate delirium
T/F: Aromatherapy, acupuncture, and comfort foods are NOT advised for management of depression for end-of-life care
FALSE
How should counseling and behavioral therapy be directed for end-of-life and palliative care patients?
- focus on goal-attainment and adaptive coping
- providing opportunity for reflection concerning death and providing meaning-oriented psychological therapy
T/F: For patients who are angry and dying, the “10 rules for engaging the angry dying patient” is more effective than taking them as meds
TRUE
T/F: Caregiver burden was not a major consequence of the 1960s de-institutionalization movement
FALSE: Caregiver burden was a major consequence for the 1960s deinstitutionalization movement
What types of stressors contribute to the caregiver burden?
physical, psychological, emotional, social and financial stressors
What are two types of burdens?
Objective burden vs. Subjective burden
What are examples of objective burdens?
- constraints on social activities
- negative effects on family life
- extra costs, lower earnings
- time spent performing ADL or medical care
- doctor’s waiting rooms/ER
What are examples of subjective burden?
-anger, grief, guilt, exhaustion, anxiety, depression, fear, illness
What are benefits for caregivers?
- maintain higher physical performance
- do significantly better on memory tasks
- less susceptible to cognitive decline
- have meaning to their life and know that they are giving back to someone else
What are methods we can implement societally to help caregivers?
- paying caregivers salaries competitive with professional healthcare caregivers
- encourage growth of telecommuting jobs that enable caregivers to work at home
- providing full medical benefits for caregivers and their patients
- providing nursing and medical advice when needed
- provide psychological counseling and psychiatric intervention for stress management
- collecting data to to document savings for national healthcare made possible by home caregivers
T/F: shifts in industrialization, urbanization, and economic development have NOT altered the relationship between death and social structures.
FALSE: they HAVE altered the relationship between death and social structures
T/F: preindustrial societies emphasized individual nuclear households and a secular society.
FALSE: preindustrial societies emphasized kinship, joint households and religion
There is no ICD10 code for Caregiver Syndrome even though it is largely accepted and identified by physicians
TRUE
What are the main changes that have impacted how bereavement is perceived?
- decline of kinship and religion
- nuclearization and high mobility of family
- diminished sense of community
- disengagement of elderly
T/F: Modern institutions have encouraged death and dying at home
FALSE: Modern institutions have removed death from the home; makes survivors less equipped to deal with the aftermath of death because aspects of death and dying are concealed from the families
What are changes that have been made in the American concept of mourning?
-supposed to be brief and private, displaying grief in public is bad taste
T/F: Macroinstitutions like the law, workplace, funeral homes and medical care systems constrain individuals’ bereavement behaviors
True
What do laws governing the disposal of bodies ensure?
They ensure the health of the community and are carried out by specialists
What do these changes in law governing disposal of bodies reflect?
Reflects changes in public health and the dependence on external support since extended family and community network is scarce
How do work policies negatively affect the bereavement process?
Most occupations only allow a limited amount of time off, making people feel that they must perform adequately after only a few days
Why is social support important in bereavement?
it provides information and problem-solving skills and individual can raw on to solve basic task and devise strategies for meeting life cycle transitions
What are four aspects of social support that facilitate recovery?
- enhancing self-esteem and feeling of being loved
- problem-solving
- networking
- providing relationship resources for meeting lifecycle transitions
T/F: Cultural forms of mourning rituals are different and their structure is different
FALSE: cultural forms of mourning rituals are different but they have the same structure- idea that grieving everywhere must be experienced
What are some challenges for bereavement in diverse communities like in the United States?
- social institutions may not be available for certain communities (i.e. lack of access to Spanish-speaking clergy to organize religious rituals)
- most traditional funeral homes and health care facilities would not tolerate traditional enactments of grief
- in most societies spiritual suffering is regarded as central to grieving and is seen as a group problem- not reflected in American concept of grieving
What factors contribute to how bereavement is experienced and handled?
- economic and sociopolitical factors
- intracultural and intercultural differences
What are three types of cancers that cause the most global economic impact?
- Lung cancer
- colon/rectum cancer
- breast cancer
Which cancers/diseases are most prevalent in developed countries vs. developing countries?
- developed countries: lung, colorectal, breast, prostate cancer
- developing: liver, cervical stomach cancer, infectious disease
What are universal consequences of alcoholism/addiction?
- psychological dependence
- tolerance
- withdrawal (acute and post-acute)
- loss of control
- progressive physical, psychological, social & spiritual damage
T/F: Palliative care for addicts consists of pain that is often over-treated
FALSE: palliative care for addicts consists of pain that is often undertreated because of their high tolerance to medication levels and fear of patient abusing treatment
What considerations must be made when providing palliative care for addicts?
- careful monitoring and assessment of patients
- utilizing multidisciplinary team approaches
- encouraging participation in recovery programs
- utilization of pill counts and urine toxicology screenings
