Non-Pain 1 Flashcards
1
Q
When managing non-pain symptoms, should choose treatment strategies that support the patient’s goals of care
A
- Age
- Functional Status
- Overall Needs
- Rate of change of the disease
- Life expectancy
2
Q
Don’t treat the symptoms, treat the _____ of the disease whenever possible
A
CAUSE
3
Q
Goal setting with Geriatrics
A
- Are the goals achievable?
- Are the goals beneficial?
- —extend life or improve comfort?
- How will the results be measured… timeframe to reassess and decide whether to continue or stop the intervention.
4
Q
Most common non-pain symptoms in palliative care
A
- Constipation
- Nausea and vomiting
- Diarrhea
- Bowel Obstruction
- Anorexia and Cachexia
- Delirium
- Depression
- Dyspnea
5
Q
Dyspnea is common is which diseases?
A
- Cancer
- COPD
- HIV/AIDS
- CHF
- ALS
- Dementia
- Tends to worsen as death approaches
6
Q
Assessing Dyspmea
A
- Dyspnea is SUBJECTIVE
- Self-report the gold standard
- RR, signs of increased WOB, oxygen saturation, and other tests DON’T correlate with patient reporting dyspnea
- Rx is dependent upon prognosis, goals of care, risks and benefits of tests/interventions
7
Q
Causes of Dyspnea
A
BREATH AIR mneumonic
- Bronchospasm
- Rales
- Effusion
- Airway obstruction
- Thick Secretions
- Hemoglobin is low
- Anxiety
- Interpersonal issues
- Religious concerns
8
Q
Treatment for Dyspnea
A
- Oxygen
- Opioids (first line)
- Anxiolytics (treat anxiety, not dyspnea)
- General Measures
- Alternative, Complimentary- things like acupressure, acupuncture, meditation, massage
- Non-invasive ventilator support (CPAP)
9
Q
General, non “medical” interventions for treating dyspnea
A
- Reduce exertion/energy expenditure
- Reposition the patient- upright or the compromised lung down
- Provide skin care for the buttocks
- Improve air circulation
- Address anxiety and provide reassurance
- Discuss any patient, family, or staff concerns about using opioids to relieve dyspnea
10
Q
General things to assess with Dysphagia
A
- “difficulty swallowing”
- Discern whether it is neurologic or non-neurologic—- things like solids progressing to liquids (obstruction) and simultaneous solids and liquids (neurologic)
- Conservative management can ameliorate dysphagia for the majority of patients
- — emphasize good oral hygiene
11
Q
Reversible causes of anorexia
A
- Aches and Pains
- Nausea and GI dysfunction
- Oral Candidiasis
- Reactive (or organic) depression
- Evacuation problems (constipation, retention)
- Xerostomia (dry mouth)
- Iatrogenic (radiation, chemo, drugs)
- Acid-related problems (gastritis, peptic ulcers)
12
Q
Anorexia Treatment
A
Appetite stimulants- -- megestrol Acetate -- Corticosteroids -- Eicosapentaenoic acid -- Thalidomide -- Cannabinoids Artificial Nutrition and Hydration -- Enteral feedings (tube) -- Parenteral feeding -- The benefits of artificial nutrition for palliative care patients are difficult to identify
13
Q
Reframing Requests for artificial Hydration and Nutrition
A
- Validate their concern
- Suggest other alternative interpretation
- share more info and give alternative explanation and suggestions
14
Q
Nausea and Vomiting- General
A
- In seriously and terminally ill patients, these two symptoms are extremely common.
- Nausea and vomiting can cause significant distress
- Can usually be controlled in over 90% of patients
15
Q
Treatment strategies for Nausea and vomiting
A
- Select an antiemetic agent based on the likely cause, pathway mediating the symptoms, and neurotransmitters involved
- Other general measures, like small and frequent meals, frequent small sips of fluids, avoiding strong odors or unpleasant tastes, and address nonphysical symptoms like psychological, social, and spiritual
