Palliative Care Flashcards
1
Q
palliative care
A
- aims to receive suffering
- improve QOL and dying
- physical, psychosocial, social, and spiritual needs
- started at time of diagnosis
2
Q
starting palliative care early
A
- extending life
- relationship with care team
- improves QOL early on
3
Q
when palliative care is indicated
A
- if not surprised if person died in 6-12 months
4
Q
palliative care requires:
A
- set of knowledge, attitudes, and skill based competencies
5
Q
most effective palliative care
A
- delivered by interdisciplinary collaboration
6
Q
integral part of palliative care
A
- grief and bereavement care
7
Q
palliative assessments
A
- Edmonton symptom assessment
- palliative performance scale
8
Q
causes of pain
A
- disease itself
- treatment of disease
- factors unrelated to disease
9
Q
barriers to pain control
A
- not being able to voice
- sedation
- stigma
- worry about addiction/tolerance
- past experience with pain meds
- HCP feelings regarding pain control
10
Q
goal of palliative care
A
to provide comfort
11
Q
only med that has a ceiling
A
codeine
12
Q
types of pain
A
- nociceptive
- neuropathic
- central
- sympathetically maintained
13
Q
nociceptive pain
A
- damage to bone and soft tissue
- somatic - localized sharp dull
- visceral - regional
14
Q
neuropathic pain
A
- from injury to central, peripheral, or autonomic NS
- dysphasia - burning
- neuralgic - shock
- mixed
15
Q
central pain
A
- from damage to CNS
- post stroke
16
Q
sympathetically maintained pain
A
- regional pain syndrome
- disproportionate to what you would expect
17
Q
10 principles of pain management
A
- avoid delay
- by the ladder
- by the mouth
- by the clock (scheduled)
- with breakthrough
- for the individual
- all aspects of suffering
- monitor efficacy
- identify and treat underlying cause
- pain is multidimensional
18
Q
WHO pain ladder - mild pain
A
- 1-3/10
- non-opioid
- +/- adjuvant
19
Q
WHO pain ladder - moderate pain
A
- 4-6/10
- weak opioid (codeine, tramadol)
- +/- adjuvant
20
Q
WHO pain ladder - severe pain
A
- 7-10/10
- strong opioid
- +/- adjuvant
21
Q
1st line opioids
A
- morphine
- hydromorphone
- oxycodone
22
Q
2nd line opioids
A
- fentanyl
23
Q
3rd line opioids
A
- methadone
24
Q
opioid conversion always based on what dose
A
morphine dose
25
cross allergy between what opioids
- codeine and morphine
26
adjuvants
- NSAIDs
- cannabis
- corticosteroids (dexamethasone)
- anticonvulsants (gabapentin, pregamblin)
- antidepressants
- radiation
- biphosphonates (bone mets)
27
breakthrough pain is what % of total daily dose
- 10%
| - q1hr PRN
28
opioid routes
- PO
- subcue
- IV
- transdermal
- intranasal
- intrabuccal
- IM
29
starting an opioid
- immediate release form q4hrs
30
switching to fentanyl patch
- changed q3days
- convert to morphine dose
- not used as breakthrough
- continue q4h dosing for 8-16hrs while patch kicks in
- dose change = take off low dose patch and put on new high dose
31
opioid side effects
- depressed respiratory rates
- constipation
- itchy
- nausea (metoclopramide 1st line)
- sedation
32
signs of opioid toxicity (7)
- myoclonus (decreased movement)
- hallucinations
- agitation
- somnolence
- cognitive dysfunction
- hyperalgesia
- delirium/confusion
33
treatment for opioid toxicity
- hydration
| - decrease/switch opioid
34
what % to decrease dose by for opioid toxicity
decrease 24hr dose by 20% due to cross tolerance
35
what antiemetic can cause long QT syndrome
domperidone
36
what antiemetic works for hiccups
metoclopramide
37
what not to give if risk for bowel obstruction
metoclopramide
38
malignant bowel obstruction treatment
- IV fluids
- NPO (alternate med routes)
- octreotide (decrease secretions)
- dexamethasone (decrease inflammation)
- bucospan (decrease spasms)
39
dementia
- onset months - years
| - symptoms generally stable with some fluctuations
40
depression
- onset weeks - months
| - symptoms generally stable
41
delirium
- onset hours - days
| - symptoms fluctuate
42
types of delirium
- hyperactive
- hypoactive
- mixed
43
hyperactive delirium
- increases risk of harm
| - more urget management
44
hypoactive delirium
- may be overlooked
- easily missed
- "pleasantly confused"
45
mixed delirium
- more variable
46
depression, anxiety, and grief
- major depression in a minority of pts
- supportive counselling in mainstay
- some pts require antidepressants
- rely on non-pharm for anxiety
- identify individuals with complicated grief
47
why do people ask to end life
- uncontrolled pain
- psychological factors
- social concerns
- loss of dignity or control
- mostly r/t fear of future suffering
- MAID is not component of palliative care
48
last days & hours of life (10)
- prepare early
- plan setting of death
- encourage funeral planning
- educate family
- spiritual and religious needs
- review goals of care
- d/c meds no longer needed
- benefits/burden of hydration
- prepare for inability to swallow (different med routes)
- identify those at risk for massive bleeding
49
sign death is imminent (6)
- increased sleeping/unconsciousness
- decreased intake
- change in resp rate and rhythm (Cheyne stokes)
- decreased peripheral perfusion
- skin mottling
- airway secretions (death rattle)
50
what to do when death is imminent
- d/c vitals and O2 sats
- continue to use O2 if have been
- apply O2 if looks distressed
