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Acute Health Challenges > Palliative Care > Flashcards

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
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2
Q

starting palliative care early

A
  • extending life
  • relationship with care team
  • improves QOL early on
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3
Q

when palliative care is indicated

A
  • if not surprised if person died in 6-12 months
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4
Q

palliative care requires:

A
  • set of knowledge, attitudes, and skill based competencies
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5
Q

most effective palliative care

A
  • delivered by interdisciplinary collaboration
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6
Q

integral part of palliative care

A
  • grief and bereavement care
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7
Q

palliative assessments

A
  • Edmonton symptom assessment

- palliative performance scale

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8
Q

causes of pain

A
  • disease itself
  • treatment of disease
  • factors unrelated to disease
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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
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10
Q

goal of palliative care

A

to provide comfort

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11
Q

only med that has a ceiling

A

codeine

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12
Q

types of pain

A
  • nociceptive
  • neuropathic
  • central
  • sympathetically maintained
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13
Q

nociceptive pain

A
  • damage to bone and soft tissue
  • somatic - localized sharp dull
  • visceral - regional
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14
Q

neuropathic pain

A
  • from injury to central, peripheral, or autonomic NS
  • dysphasia - burning
  • neuralgic - shock
  • mixed
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15
Q

central pain

A
  • from damage to CNS

- post stroke

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16
Q

sympathetically maintained pain

A
  • regional pain syndrome

- disproportionate to what you would expect

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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
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18
Q

WHO pain ladder - mild pain

A
  • 1-3/10
  • non-opioid
  • +/- adjuvant
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19
Q

WHO pain ladder - moderate pain

A
  • 4-6/10
  • weak opioid (codeine, tramadol)
  • +/- adjuvant
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20
Q

WHO pain ladder - severe pain

A
  • 7-10/10
  • strong opioid
  • +/- adjuvant
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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
Q

cross allergy between what opioids

A
  • codeine and morphine
26
Q

adjuvants

A
  • NSAIDs
  • cannabis
  • corticosteroids (dexamethasone)
  • anticonvulsants (gabapentin, pregamblin)
  • antidepressants
  • radiation
  • biphosphonates (bone mets)
27
Q

breakthrough pain is what % of total daily dose

A
  • 10%

- q1hr PRN

28
Q

opioid routes

A
  • PO
  • subcue
  • IV
  • transdermal
  • intranasal
  • intrabuccal
  • IM
29
Q

starting an opioid

A
  • immediate release form q4hrs
30
Q

switching to fentanyl patch

A
  • 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
Q

opioid side effects

A
  • depressed respiratory rates
  • constipation
  • itchy
  • nausea (metoclopramide 1st line)
  • sedation
32
Q

signs of opioid toxicity (7)

A
  • myoclonus (decreased movement)
  • hallucinations
  • agitation
  • somnolence
  • cognitive dysfunction
  • hyperalgesia
  • delirium/confusion
33
Q

treatment for opioid toxicity

A
  • hydration

- decrease/switch opioid

34
Q

what % to decrease dose by for opioid toxicity

A

decrease 24hr dose by 20% due to cross tolerance

35
Q

what antiemetic can cause long QT syndrome

A

domperidone

36
Q

what antiemetic works for hiccups

A

metoclopramide

37
Q

what not to give if risk for bowel obstruction

A

metoclopramide

38
Q

malignant bowel obstruction treatment

A
  • IV fluids
  • NPO (alternate med routes)
  • octreotide (decrease secretions)
  • dexamethasone (decrease inflammation)
  • bucospan (decrease spasms)
39
Q

dementia

A
  • onset months - years

- symptoms generally stable with some fluctuations

40
Q

depression

A
  • onset weeks - months

- symptoms generally stable

41
Q

delirium

A
  • onset hours - days

- symptoms fluctuate

42
Q

types of delirium

A
  • hyperactive
  • hypoactive
  • mixed
43
Q

hyperactive delirium

A
  • increases risk of harm

- more urget management

44
Q

hypoactive delirium

A
  • may be overlooked
  • easily missed
  • “pleasantly confused”
45
Q

mixed delirium

A
  • more variable
46
Q

depression, anxiety, and grief

A
  • 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
Q

why do people ask to end life

A
  • 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
Q

last days & hours of life (10)

A
  • 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
Q

sign death is imminent (6)

A
  • increased sleeping/unconsciousness
  • decreased intake
  • change in resp rate and rhythm (Cheyne stokes)
  • decreased peripheral perfusion
  • skin mottling
  • airway secretions (death rattle)
50
Q

what to do when death is imminent

A
  • d/c vitals and O2 sats
  • continue to use O2 if have been
  • apply O2 if looks distressed

Acute Health Challenges (7 decks)

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