Pallative care/pain management

Question 1

End of life secretion management (non pharm and pharmacological

Answer 1

NON-PHARMALOGICAL
Do NOT deep suction
Frequent oral care
Reposition head

PHARMALOGICAL
Scopolamine patch (behind ear) every 72 hours
Glycopyrrolate 0.1-0.2mg IV every 6 hours PRN or STANDING

Question 2

Dyspnea management

Answer 2

NON-PHARMALOGICAL
Hand held or paper fan (stimulates the thermal/mechanical receptors of trigeminal nerve)

PHARMACOLOGIAL
Opioids- (see pain slides)
Benzodiazepines – Scheduled Ativan 1mg every 4 hours

Question 3

Anxiety management (non pharm, phar,

Answer 3

NON-PHARMALOGICAL
Ensure peaceful environment
Remove any lines/tubes that are unnecessary
Ensure no constipation/urinary retention

PHARMALOGICAL
Ativan 0.5-1mg every 2-4 hours prn anxiety
Haldol 0.5-1mg every 8 hours prn agitation

Question 4

S in Spikes stands for

Answer 4

Setting: Choose a private comfortable

Question 5

P in SPIKES stands for

Answer 5

Perception: uncover what the patient & family think is happening

Question 6

I in SPIKES stands for

Answer 6

Invitation: Ask the patient what they would like to know

Question 7

K in SPIKES stands for

Answer 7

Knowledge: Explain disease and care options in plain language

Question 8

E in SPIKES stands for

Answer 8

Emotion: Respect feelings with empathy

Question 9

S in SPIKES stands for

Answer 9

Summarize: Recap and decide what’s next

Question 10

Things to monitor with Opiod use

Answer 10

O2 monitoring, O2 available, end tidal monitoring, VS sign monitoring, frequent evaluation of needs, monitor S/E, STOP BANG OSA screening

Question 11

Hydromorphone is

Answer 11

100x more potent than Morphine
immediate onset
30-60 min duration
SE; Bradycardia

Question 12

Tramadol

Answer 12

Avoid with SSRI’s- risk for serotonin syndrome (agitation, tachycardia, hyperthermia, N/V) and increased seizure risk

Question 13

Methadone can

Answer 13

Prolong QT/QTc and takes weeks to reach steady state

Question 14

Ketamine is a

Answer 14

NMDA agonist indicated for acute traumatic or post-op pain or refractory neuropathic pain S/E increased HR, BP, CO and SVR

Question 15

Gabapentin is a

Answer 15

Neuropathic agent- anticonvulsant,, binds to alpha 2/delta 1 subunit of voltage gated channels to work on brainstem, dorsal horn and periphery, Rx’d for neuropathic pain, max 1800 mg/d

side effects: sedation, ataxia and dizziness

Question 16

(TCAs and SNRIs) are useful for

Answer 16

neuropathic and persistent pain, not for acute pain,inhibit serotonin and norepi reuptake with SNRIs having a better safety profile

ex. Amytriptiline (TCA), Duoloxetine, sertraline, fluoxetine