Palliative

Question 1

6 criteria for MAID

Answer 1

1. Eligible for health services funded by province/territory
2. At least 18 years old
3. Mentally competent (capable of making decisions)
4. Have a grievous and irremediable medical condition
   a. Serious illness, disease or disability
   b. Be in advanced state of decline that can’t be reversed
   c. Experience unbearable physical/mental suffering, can’t be relieved under acceptable conditions
   d. Mental illness alone doesn’t qualify
5. Make a voluntary request for MAID
6. Give informed consent to receive MAID
   a. Received all info to make decision
   b. Must be able to provide at time of request and immediately before receiving

Question 2

8 reasons to consult palliative care

Answer 2

1. Symptom management
2. Goals of care discussions
3. Prognostication
4. Advanced care planning (POA, care setting, code status)
5. Caregiver support
6. End of life management
7. Psychosocial and spiritual support
8. Care coordination

Question 3

3 pharm and 1 non pharm approach for bowel obstruction

Answer 3

1. Opioids for pain
2. Antisecretory drugs ex. octreotide
3. Antiemetics ex. Haldol, olanzapine, metoclopramide (if not complete)
4. Glucocorticoids ex. IV dex, to minimize edema around tumour
   Non Pharm
5. NGT for gastric decompression
6. IVF for dehydration to correct lytes

Question 4

Likelihood of survival after CPR (IHCA)

Answer 4

15% >75 will survive
25% general pop

Question 5

Post CPR survival to hospital discharge rates (IHCA)

Answer 5

70-79 18.7% (20-28%)
80-89 15.4% (15-21%)
>90 11.6% (11-15%)

Question 6

What percentage of people go home independent vs. needing help vs. to LTC after CPR survival?

Answer 6

Independent 25%
Assistance 25%
LTC 50%

Question 7

Rate of neurologic impairment post CPR

Answer 7

50%

Question 8

What is a living will?

Answer 8

A legal document telling doctors how you want to be treated it you can’t make your own decisions

Question 9

What is the purpose of a living will?

Answer 9

Explain what common medical treatments you would want, what you would want to avoid and under what conditions these apply

Question 10

Benefits and drawbacks to living will

Answer 10

Benefits: remind SDM of wishes, reduce stress for SDM, prevents unwanted care, enhances autonomy
Drawbacks: hard to interpret, too vague/specific, update if wishes change

Question 11

Outline of living will

Answer 11

1. POA and contact info
2. Wishes if terminal condition: life sustaining tx, artificial nutrition and hydration, comfort care
3. Wishes if persistent vegetative state: life sustaining tx, artificial nutrition and hydration, comfort care

Question 12

What is the PPS?

Answer 12

Valid functional assessment tool to measure physical status of palliative care patients
Based on: ambulation, activity/evidence of disease, self care, intake and LOC
Three stages: stable 70-100%, transitional 40-70%, EOL <30%
Can be used for: prognostication, disease monitoring, care planning, teaching/research, communication tool b/w HCW

Question 13

4 issues to discuss when developing palliative care strategy for patient with dementia

Answer 13

1. ED visits
2. Symptom management
3. Prognostication
4. GOC/EOL conversations

Question 14

8 symptoms/signs of opioid induced neurotoxicity

Answer 14

Hypersomnolence
Delirium
Hallucinations
Allodynia
Hyperalgesia
Myoclonus
Tremor
Seizures

Question 15

Opioid rotation

Answer 15

1. Reduce total dose by 25-50%
2. 10 mg morphine = 2 mg HM PO and 1 mg SC/IV

Question 16

2 pharmacokinetic and 2 pharmacodynamic changes of morphine in the elderly

Answer 16

Pharmacokinetic
1. Dec 1st pass = inc morphine conc
2. Hydrophilic = small er VOD = higher conc
3. Dec renal function = dec clearance
Pharmacodynamic
1. Inc analgesic effect
2. Inc susceptibility to sedation