Pain in Palliative Care: Assessment Flashcards
aims to relieve suffering and improve quality of living and dying in those pts diagnosed with progressive incurable illness
palliative care
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
2- at any point of a life limiting disease
when should palliative care be offered?
if pt is expected to die in next 12 mths or if pt is symptomatic (even if not dead in 12mths)
Who requires palliative care?
Cancer pts
Noncancer pts: ESRD, COPD, PF, PD, MS, ALS, ESLD, AIDs, Alzheimers, pediatrics MD
the biggest component of palliative care is
communication
Consult service are for levels
R1-C2
TPCU stands for
tertiary palliative care unit
TPCU are for levels
M1-C2
hospice is for levels
C1-C2`
EOL care is for levels
C2
list 3 palliative care providers
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
paliative care is a mandatory rotation in
family medicine residency program at UoA
___% pts with advanced cancer experience pain-___% rate their pain as mod-severe
85%
67%
what pts are more likely to experience neuropathic pain?
cancer, AIDs,MND
T or F: 85% of pain in palliative pop can be controlled
T
causes of pain n palliative pts
terminal illnesses like cancer
preexisting pain conditions like fibromyalgia, DM
what are some direct causes of pain from cancer
invasion of tissues, organs, bones = nociceptive somatic or visceral pain
invasion of nerves = neuropathic pain
paraneoplastic phenomena, altered nerve conduction
invasion of tissues, organs, bones causes ____ pain
nociceptive
Invasion of nerves causes ____ pain
neuropathic
what are some indirect causes of cancer pain
constipation, obstruction, fissures
what are some treatment causes of cancer pain
chemo (neuropathies), radiation (burns, pain flare), surgical complications (infections wounds, phantom pain)
what are some family/ pt barriers to good pain control
Opioids (addictions/ SEs/ loss of efficacy over time)
Stoicism, Fear that complaining will annoy caregivers
Financial concerns
Cognitive impairment
Lack of compliance
what are some HCP barriers to good pain control
Skills required
Fear of addictions + reprimand
Failure to recognize multidimensionality of pain
Underestimating extent of pain
what is total pain
pain experience originates from a number of sources including physical, social, psychological, and/or spiritual domains = must assess all domains + classify to treat appropriately
what PPS % are the majority of palliative pts at
20-30, 40% if early palliative care
what is the ESASr
9+ sx rating on numerical rating scale of 0-10
the more white the ESASr graph, the ____ the functioning
better
why is the ESASr graphed?
to visualize how sx are improving/ worsening over time
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
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
what is the ECS-CP
Edmonton classification system for cancer pain
how does the ECS-CP report pain
mech of pain
incidence of pain
psych distress
addictive behaviour
cognitive function
Nc=
nociceptive pain
Ne =
neuropathic pain
Nx =
unable to classify
Io =
no incident pain
Ii
incident pain
Ix
unable to classify
Po =
no PD
Pp
PD present
Px
unable to classify
Ao=
no addictive behaviour
Aa
addictive behaviour present
Ax
unable to classify addictive behaviour
what is Co
no cog problems
Ci is
partial cog fxn impairment
Cu is
total cog fx impairment
Cx is
unable to classify cog impairment
what does NcIiPxAaCi mean
nociceptive pain
incident pain
unable to classify psyc distress
addictive behaviours present
partial cog fxn impairment
