Nurb End of life symptom management Flashcards
i. Assessment and evaluation
ii. Interdisciplinary teamwork
iii. Economics: costs, and what going to do, is there a purpose, reimbursement
iv. Indications of diagnostic tests
v. Research
a. EOF
Essential elements of symptom management
b. Priority symptoms
c. : suffering and distress, psychosocial intervention is key to complement pharmacologic strategies
EOF
Symptoms and suffering
– may cause significant distress to pt and family, determine the cause, comfort care
-Pt symptomatic: see what they can do to alleviate when dying , monitors turn down or away
EOF
II. Common Symptoms
– distressing shortness of breath, associated disease, mostly subjective
- Causes: Pulmonary- COPD, Cardiac- CHF, Neuromuscular -ALS
- Assessment
a. Subjective report of patient- what every they say it is/ decrease o2 sat, increased resp rate
b. Impact on function and quality of life
c. Clinical assessment
a. Respiratory Symptoms
i. Dyspnea
- pre-medicate for extabation
a. : opioid, Bronchodilators, diuretics
b. : oxygen= even if o2 sat is high make feel better, counseling, pursed lip breathing, energy conservation, fans, elevation
- give morphine to ease pain
a. Respiratory Symptoms dyspnea treatment A. Pharmacologic B. Non-pharmacologic Terminal dyspnea
- annoying, interferes with sleep=fatigue, worse N/V, common symptom in advanced disease
1. assess underlying cause- choice of test up to fam and pt
2. A.suppressants=dem in name, antibiotics, steroid, anticholinergic
B. : humidifier, chest pt, positioning
Cough
- Causes:
- Treatment
a. Pharmacologic
b. Non-pharmacologic:
- loss of appetite, usually with decreased intake
- lack of nutrition and wasting, extreme symptom, just skin and bones Ex: refugee
b. GI Symptoms
i. Anorexia
ii. Cachexia
Assessment
a. Physical findings
b. Impact on function and quality of life
c. Impact on self/family
d. Calorie counts/daily weights- will we do anything about it cost benefit
e. Laboratory tests
f. Skin breakdown
Gi symptoms
EOF
a. Dietary consult/dietary interventions- what they want, let them eat but don’t make them
b. Medications
c. Paraenteral or enteral nutrition
d. Problem odors control
e. Counseling
GI symptoms EOF
3. Treatment
- Causes- Disease related, Treatment related
- Assessment
a. Bowel history- important
b. Abdominal assessment- check for bowl obstruction
c. Rectal assessment
d. Medication review
iii. Constipation
- Medications: try oral route first, then try rectal Laxatives and enemia
iii. Bowel obstruction in eof- so many variables how are they doing over all are they actively dying, or just terminally ill, do they want anything done
iv. Dietary and fluid interventions- encourage fluids as able, more fiber, if able increase activity
v. Additional approached- symptom management
vi. Complementary approaches - min goal is to have a bowel movement every 72 hours
treatment constipation
– frequent passage of loose non formed stool
- Effects fatigue caregiver burden, skin breakdown
- work with them there to help them, have done it before, reassure
1. Causes: Disease related, Psychological, Treatment related, concurrent disease, malabsorption
iv. Diarrhea
a. Bowel history
b. Medication review
c. Evaluate for infectious process
diarrhea
2. Assessment
a. etiology as appropriate- underlying cause, decrease amount of fiber, adequate hydration=electrolytes, can consider IV fluid =is it considered for what care they want to
b. Dietary modification (increase bulk, decreased gas-producing foods)
c. Medications
d. Hydration
diarrhea
treament
– 70 percent, common in advanced disease, etiology
1. Causes: Physiological (GI, metabolic, CNS), Psychological (burden) , Disease related, Treatment related
v. Nausea/vomiting
