Pain in Palliative Care: Assessment Flashcards

1
Q

aims to relieve suffering and improve quality of living and dying in those pts diagnosed with progressive incurable illness

A

palliative care

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2
Q

which of the following is false about palliative care?
1. it addresses physical,. psych, social, and spiritual needs
2. it is End of life care
3. it improves QoL, mood ,and survival compared to standard care pts
4. it can prevent unnecessary or overaggressive tx at EOL

A

2- at any point of a life limiting disease

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3
Q

when should palliative care be offered?

A

if pt is expected to die in next 12 mths or if pt is symptomatic (even if not dead in 12mths)

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4
Q

Who requires palliative care?

A

Cancer pts
Noncancer pts: ESRD, COPD, PF, PD, MS, ALS, ESLD, AIDs, Alzheimers, pediatrics MD

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5
Q

the biggest component of palliative care is

A

communication

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6
Q

Consult service are for levels

A

R1-C2

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7
Q

TPCU stands for

A

tertiary palliative care unit

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8
Q

TPCU are for levels

A

M1-C2

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9
Q

hospice is for levels

A

C1-C2`

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10
Q

EOL care is for levels

A

C2

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11
Q

list 3 palliative care providers

A

Family physicians in community- is a mandatory rotation n family medicine residency program at the UoA
Hospital doctors and specialists- is an elective for med students/ other residency programs (oncology, cardio, neuro, GI, ID, pulmonology, nephro, surgery, emerg, anesthesia, geriatrics, psych)
Community consult team (PEOLC)
Palliative specialists and residents
Pharmacists in both institutional and community settings
Nurses and allied professionals in community and hospital (OT, pT, etc)
Chaplains, social workers, music therapists, psychologists, psychiatrists
Family, friends, pets, volunteers

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12
Q

paliative care is a mandatory rotation in

A

family medicine residency program at UoA

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13
Q

___% pts with advanced cancer experience pain-___% rate their pain as mod-severe

A

85%
67%

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14
Q

what pts are more likely to experience neuropathic pain?

A

cancer, AIDs,MND

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15
Q

T or F: 85% of pain in palliative pop can be controlled

A

T

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16
Q

causes of pain n palliative pts

A

terminal illnesses like cancer
preexisting pain conditions like fibromyalgia, DM

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17
Q

what are some direct causes of pain from cancer

A

invasion of tissues, organs, bones = nociceptive somatic or visceral pain
invasion of nerves = neuropathic pain
paraneoplastic phenomena, altered nerve conduction

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18
Q

invasion of tissues, organs, bones causes ____ pain

A

nociceptive

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19
Q

Invasion of nerves causes ____ pain

A

neuropathic

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20
Q

what are some indirect causes of cancer pain

A

constipation, obstruction, fissures

21
Q

what are some treatment causes of cancer pain

A

chemo (neuropathies), radiation (burns, pain flare), surgical complications (infections wounds, phantom pain)

22
Q

what are some family/ pt barriers to good pain control

A

Opioids (addictions/ SEs/ loss of efficacy over time)
Stoicism, Fear that complaining will annoy caregivers
Financial concerns
Cognitive impairment
Lack of compliance

23
Q

what are some HCP barriers to good pain control

A

Skills required
Fear of addictions + reprimand
Failure to recognize multidimensionality of pain
Underestimating extent of pain

24
Q

what is total pain

A

pain experience originates from a number of sources including physical, social, psychological, and/or spiritual domains = must assess all domains + classify to treat appropriately

25
what PPS % are the majority of palliative pts at
20-30, 40% if early palliative care
26
what is the ESASr
9+ sx rating on numerical rating scale of 0-10
27
the more white the ESASr graph, the ____ the functioning
better
28
why is the ESASr graphed?
to visualize how sx are improving/ worsening over time
29
what are the 4 questions of CAGE?
Cut down on drinking Annoyed you by criticizing drinking? Guilty about drinking Need a drink first thing in the morning as an Eyeopener? Score >2/4 = + CAGE
30
name some tests for cognition
Folstein’s mini mental state exam Confusion assessment method (CAM) mini-Cog (clock drawing and memory) Blessed orientation memory concentration est (BOMC) MOCA (executive fxn)- unable to use rn = use SLUMS as alt
31
what is the ECS-CP
Edmonton classification system for cancer pain
32
how does the ECS-CP report pain
mech of pain incidence of pain psych distress addictive behaviour cognitive function
33
Nc=
nociceptive pain
34
Ne =
neuropathic pain
35
Nx =
unable to classify
36
Io =
no incident pain
37
Ii
incident pain
38
Ix
unable to classify
39
Po =
no PD
40
Pp
PD present
41
Px
unable to classify
42
Ao=
no addictive behaviour
43
Aa
addictive behaviour present
44
Ax
unable to classify addictive behaviour
45
what is Co
no cog problems
46
Ci is
partial cog fxn impairment
47
Cu is
total cog fx impairment
48
Cx is
unable to classify cog impairment
49
what does NcIiPxAaCi mean
nociceptive pain incident pain unable to classify psyc distress addictive behaviours present partial cog fxn impairment