Module 3 Hospice Care Flashcards
0
Q
Sufferer’s experience of the disease
A
Illness
1
Q
Biology; Pathophysiology
A
Disease
2
Q
Short Period of Evident Decline
A
Cancer
3
Q
Diminished hearing
A
Age- related sensory changes
4
Q
Impaired vision
A
Age related sensory changes
5
Q
Reduced reaction time
A
Age related neurologic changes
6
Q
Cognitive Impairent
A
Age related neurologic changes
7
Q
atrophy & disappearance of cells in the inner ear
A
auditory system aging
8
Q
angiosclerosis in the inner ear
A
Auditory system aging
9
Q
Degeneration of VIII cranial nerve & canal closure
A
Auditory system aging
10
Q
Atrophy and cell loss of brainstem & cortical auditory centers
A
Auditory system aging
11
Q
hearing loss for pure tones
A
Peripheral pathology
12
Q
hearing loss for speech
A
Peripheral pathology
13
Q
problems localizing sound
A
Brainstem pathology
14
Q
problems with difficult speech
A
Cortical pathology
15
Q
problems in binural listening
A
Brainstem pathology
16
Q
language problems
A
Cortical pathology
17
Q
the auditory threshold
A
Aging in hearing loss
18
Q
sound frequency discrimination
A
Aging in hearing loss
19
Q
localization of higher frequency sounds
A
Aging in hearing loss
20
Q
discrimination of high-frequency consonants
A
Aging in hearing loss
21
Q
Increased sensitivity to background noise, loudness, recruitment
A
Aging in hearing loss
22
Q
persistent ringing or buzzing noise in the ears
A
Tinnitus
23
Q
Decrease in pupil size
A
Aging in visual changes
24
Changes in the circumference & shape of the lens
Aging in visual changes
25
Decline in size of macula lutea- Macular degeneration
Aging in visual changes
26
Proliferation of new cells at the periphery
Aging in visual changes
27
Capsule becomes less thicker & less permeable
Aging in visual changes
28
Maturation of lens fibers
Aging in visual changes
29
Promoting independence in the elderly
Self-care
30
major health concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over 75
Impaire mobility
31
Electrolyte imbalance
Hyponatremia
32
increase risk of fracture in elderly patients because it cause subtle neurologic impairment that affects gait and attention, similar to that of moderate alcohol intake.
Mild hyponatremia
33
immunization, alcohol use, tobacco use, caffeine intake, sleep patterns
Personal habits
34
Mini-Nutrition Assessment (MNA)
Dietary assessment
35
emotional difficulties and adjustments, patterns of coping with stress
Emotional history
36
living relatives, significant others
Social supports
37
Pts capacity for independent living
Functional assessment
38
Activities of Daily Living (ADL) = DEATH (dressing, eating, ambulating, toileting, hygiene)
Functional assesment
39
Instrumental Activities of Daily Living (IADL) = SHAFT (shopping, housekeeping, accounting, food preparation, transportation)
Functional assessment
40
Geriatric depression Scale is used
Assessment of depression
41
living arrangements, physical layout of homes, recommendations for adaptive devices, etc
Environmental history
42
Vital signs
Physical examtination
43
General Appearance
PE
44
HEENT examination
PE
45
Systems exam
PE
46
Neurological and Psychiatric Examination
PE
47
Assessment of gait, mobility and balance
PE
48
application of palliative care to the patient who is felt to have a terminal illness
Hospice care
49
Includes comprehensive pain and symptom control, spiritual care, psychosocial care, grief and bereavement support, and interdisciplinary team work
Hospice care
50
maximize the quality of a patients life when the quantity of that life can no longer be increased
Hospice care
51
Recognizes dying as part of the normal process of living
Hospice
52
Affirms life and neither hastens nor postpones death
Hospice
53
Focuses on quality of life for individuals and their family caregivers
Hospice
54
Providing the patient and his family with physical, social, psychological and spiritual support.
Hospice
55
The degree to which denial is adaptive or maladaptive appears to depend whether a patient continues to obtain treatment while denying the prognosis.
Shock & Denial
56
Doctor Shopping
Shock and denial
57
Patient become frustrated, irritable, and angry at being ill.
Anger
58
May represent patients desire for control in a situation in which they feel completely out of control.
Anger
59
negotiation
Bargaining
60
accepted the situation
Acceptance
61
withdrawal, psychomotor retardation, sleep disturbance, hopelessness, and suicidal ideation
Depression
62
Patient/family focused
Core aspects of hospice
63
Interdisciplinary
Core aspects of hospice
64
Develops the plan of care
Hospice team
65
Manages pain and symptoms
Hospice team
66
Attends to the emotional, psychosocial and spiritual aspects of dying and caregiving
Hospice team
67
Teaches the family how to provide care
Hospice team
68
Advocates for the patient and family
Hospice team
69
Provides bereavement care and counseling
Hospice team
70
Life-limiting illness, prognosis is 6 months or less if disease takes normal course
Admission criteria on Hospice care
71
Live in service area
Admission criteria on Hospice care
72
Consent to accept services
Admission criteria on hospice cate
73
expands traditional disease-model medical treatments to include the goals of enhancing quality of life for patients and family, optimizing function, helping with decision-making and providing opportunities for personal growth.
Palliative care
74
delivered with life-prolonging care or as the main focus of care
Palliative care
75
delivered with life-prolonging care or as the main focus of care
Palliative care
76
The expected outcome is relief from distressing symptoms, the easing of pain, and/or enhancing the quality of life
Palliative care
77
Focuses on quantity of life and prolonging of life
Curative care
78
Focuses on quality of life and death, and views death as a natural part of life
Palliative care
79
appropriate for all patients with serious illness
Palliative care
80
enhance quality of life through assiduous symptom management and attention to psychological, social and spiritual needs of the patient and family
Palliative care
81
patient and family centered care
Palliative care
82
philosophy of care
Palliative care
83
a Medicare benefit available to patients who are nearing the end of life
Palliative care
84
All ______ patients receive ________ care, but not all palliative care patients are enrolled in hospice.
Hospice, palliative
85
Pain, dyspnea/respi distress, nausea/vomiting, anorexia/cachexia
Common symptoms of palliative care
86
Pruritis/dermatitis, Intractable seizures, delirium, incontinence, pressure ulcers
Common symptoms of palliative care
87
Verbal Pain intensity scale - 0=no pain, 10=worst possible pain
Painassessment
88
Numeric Pain Intensity Scale
Pain assessment
89
Faces Chart
Pain assessment
90
Visual analog scale
Pain assessment
91
pain caused by activity in neural pathways in response to potentially tissue-damaging stimuli
Nociceptive/ inflammatory pain
92
Postoperative
| pain
Nociceptive/ inflammatory pain
93
Mechanical
| low back pain
Nociceptive/ inflammatory pain
94
Mechanical
| low back pain
Nociceptive/ inflammatory pain
95
sports or exercise injuries
Nociceptive/inflammatory pain
96
pain caused by a primary lesion or dysfunction in the peripheral and/or central nervous systems
Neuropathic pain
97
HIV sensory neuropathy
Peripheral neuropathy
98
postherpetic neuralgia (PHN)
Peripheral neuropathy
99
diabetic neuropathy
Peripheral neuropathy
100
central poststroke pain
Central neuropathy
101
spinal cord injury pain
Central neuropathy
102
trigeminal neuralgia
Central neuropathy
103
multiple sclerosis pain
Central neuropathy
104
chronic pain can be of mixed etiology with both nociceptive and neuropathic characteristics.
Mixed type
105
ASA, acetaminophen
Non-opiod analgesics
106
NSAIDs, Cox-2 inhibitors
Non-opioid analgesics
107
SNRIs, TCAs
Non-opiod analgesics
108
alpha-2 delta ligands
Non-opioid analgesics
109
anti-epileptics
Non-opiod analgesics
110
NMDA receptor antagonists
Non-opiod analgesics
111
alpha-2 delta ligands
Non-opiod analgesics
112
anti-epileptics
Non-opiod analgesics
113
NMDA receptor antagonists
Non-opioid analgesics
114
Topical analgesics_
Non-opioid analgesics
115
Naturally-occurring, semi-synthetic, synthetic, novel
Opioid analgesics
116
Immediate release, sustained release, transdermal, IV, IM
Opiod analgesics
117
Laxatives
Adjuvant therapy
118
Antihistamines
Adjuvant therapy
119
Antiemetics
Adjuvant therapy
120
Antidepressants
Adjuvant therapy
121
psychostimulants
Adjuvant therapy
122
NSAIDS for mild pain
Step 1
123
NSAIDS effective for bone and soft tissue pain
Step 1
124
If the pain persists or is of moderate intensity, weak opioids are used, eg. codeine
Step 2
125
For severe pain , strong opioids are the drug of choice
Step 3
126
paracetamol,
| aspirin, NSAIDs - +/- adjuvant
Non opioid
127
codeine,
| tramadol | +/- nonopioid | +/- adjuvant
Weak opioid
128
morphine,
oxycodone,
fentanyl | +/- nonopioid | +/- adjuvant
Strong opiod
129
______ administration of opioids is most convinient and cost-effective route
Oral
130
______ administration of opioids provides slower absorption but with little first-pass effect
Rectal
131
____ and _____ route is prefered over IM injections
IV;SC
132
Usual effective dosage interval for opioid analgesics
3-4 hours
133
Used in terminal illness
Morphine
134
Adverse effects: nausea, sedation, confusion, constipation
Morphine
135
Morphine: Two dosing rules: Much more than twice the stable tolerated dose
depress respiratory function
136
Morphine: Two dosing rules: Reestablishing pain control when stable dose becomes inadequate ordinarily
requires more than or equal to 1.5 times the previous dose
137
Only opioid administered topically via patch which releases opioid steadily for 72 hours
Fentanyl
138
At least 24 hours is needed to attain maximum analgesia and can cause confusion and delirium
Fentanyl
139
For severe pain in localized body regions
Anesthetics
140
Indwelling epidural or intrathecal catheters may be placed to provide continuous infusion of analgesics
Anesthetics
141
Nerve blocking techniques may also be used
Anesthetics
142
Causes: mouth infection, nausea, constipation, depression, drugs, radiotherapy and disease itself
Anorexia
143
Metoclopromide orally or subcutaneously
Nausea
144
Phenothiazine such as promethazine 25mg orally 4x a day or prochlorperazine 10mg orallybefore meals
Nausea and vomitting
145
SUPPORT SYSTEM THAT SERVES AS A NURSE, HOMEMAKER, SPOUSE, AND HEAD OF THE HOUSEHOLD AND MORE
Caregiver
146
state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude -- from positive and caring to negative and unconcerned.
Caregiver burnout/fatigue
147
Yes = 1 , No = 0
Caregiver strainindex
148
Role confusion, unrealistic expectations, lack of control and unreasonable demands
Causes caregiver burnout
149
Integral part of patient care
Health education
150
Central building block of the physician
Communication
151
The more I listen, the more my patients understand
Communication
152
The ability to be fully present in the moment of the interview with the person who has come for help and care
Listening skills
153
3R's fo an interview
Rapport, respect, relationship
154
"I am listening to you and I understand where you are coming from."
Attending
155
L - lean forward, O _ open stance, V _ voice of compassion, E _ eye contact, R _ relaxed position, S _ sit at an angle
Attending
156
Mental skill
Bracketing
157
Setting aside our biases, prejudices and pre- conceived notions about the situation or condition that the patient is talking about
Bracketing
158
Open invitation for the patient to talk about anything that he / she wishes
Indirect leading
159
Open invitation for the patient to talk about anything that he / she wishes
Direct leading
160
Yes? Go on... And then?
Leading
161
Paraphrasing, Perception checking
Reflecting content
162
Articulate the feelings for the patient
Reflecting feeling
163
Counselor takes note of the patient's gestures or nonverbal cues
Reflecting experiences
164
"You seem to be quite anxious about your chest pain."
Reflecting
165
Enumerate the problems brought up by the patient and identify which one is the most troublesome
Focusing
166
The patient is asked to choose which issue is most important
Focusing
167
"So you feel afraid, angry and guilty. But of these three, which is the feeling that is giving you the most pain?"
Focusing
168
Asked to elicit more information
Probing
169
Usually consist of open-ended questions
Probing
170
Probe for content or feeling
Probing
171
Time demands
Barriers to effective communication
172
Interruption
Barriers to effective communication
173
Technology
Barriers to effective communication
174
Advance preparation, Build a therapeutic environment and relationship, Communicate well, Deal with reactions, Encourage and validate
Sharing bad news
175
Caregiver, Breadwinner, Decision-maker
Important members to communicate with
