Palliative Care Flashcards

1
Q

the goal of palliative care

A

to relieve the suffering of patients with serious illness

regardless of the patient’s prognosis, relief of suffering should be a primary goal for both emergency medicine and palliative care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

remarks on hospice care

A

a branch of palliative care

a comprehensive program of palliative treatment that is appropriate when patients with chronic, progressive, and eventually fatal illness are determined to have a life expectancy of 6 months or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

remarks on palliative care

A

patient centered rather than disease centered

palliative care is guided by the axiom that distressing symptoms should be treated.
*it thus provides expert assessment and treatment of symptoms, including pain, dyspnea, and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

most common reason for seeking care in the ED

A

pain
Unfortunately, only 60% of patients reporting pain receive pain medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

remarks on assisting surrogates in making EOL care choices for patients who lack decision-making capacity

A

assist them to make EOL care choices based on the patient’s own preference, values, and goals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe a patient with decisional capacity

A

one who has the mental ability to
1) grasp and retain information about his or her condition,
2) weight risks and benefits
3) and demonstrate these abilities by verbalizing a medical decision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

most common targets of symptom management

A

pain control
dyspnea
nausea/vomiting
constipation
agitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

the biggest obstacle to aggressive pain management with opiates

A

fear of respiratory depression

respiratory depression is not a sudden occurrence, but instead is part of a progression that starts with sedation, somnolence, and then respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

remarks on IV opiates

A

IV opiates reach maximum therapeutic levels and have peak effects or side effects at 6-10 minutes

Therefore, IV pain medications can be safely redosed every 15 minutes until relief is reached if potential adverse effects are monitored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how to manage dyspnea

A

When treating breathlessness/dyspnea in an opioid-naive patient,start with morphine at a dose of 0.05 mg/kg IV, and monitor for sedation and hypoventilation

This is half of the starting dose of morphine when it is used to treat pain.

Use a goal of maintaining a RR of at least 10-12 breaths/min.

Although opioids have traditionally been withheld due to concerns about respiratory depression, opioids are beneficial in treating the agitation and anxiety provoked by dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

can be used to treat chemotherapy-induced N/V

A

ondansetron
steroids (dexamethasone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

can be used to treat N/V from increased intracranial pressure and bowel obstruction from cancer

A

steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

can be used for refractory nausea in the palliative care setting

A

dopamine antagonists such as
haloperidol
droperidol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

indications of metoclopramide

A

symptoms of diabetic gastroparesis
compression of the stomach due to tumor or ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

medications that are indicated for agitation in palliative care

A

antipsychotics such as haloperidol
anxiolytics such as midazolam
opiates such as morphine

There is no evidence that these palliative interventions hasten death.

The causes of agitation in patients with terminal illness are multifactorial, including pain, effects of the terminal illness, anxiety, terminal restlessness, breathlessness, and mental anguish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

opioids in the opioid-naive patient

A

a 2-mg dose of IV morphine or a 0.5- to 1-mg dose of hydromorphone is a reasonable starting dose

This should be administered every 15 minutes until the pain is relieved by approximately 50%

17
Q

opioids in the opioid-tolerant patient

A

the average 4-hourly dose of opioids already prescribed should be doubled for severe pain and increased by 50% for moderate pain (pain scale score of 4 to 6)

18
Q

smaller doses of opioids are required in

A

elderly patients
lower BMI
unstable VS
with baseline severe cardiorespiratory compromise (e.g. COPD)
because such patients are at risk for hypoventilation

19
Q

N/V etiologies where steroids (dexamethasone) are indicated

A

Chemotherapy-induced
Increased intracranial pressure
or Bowel obstruction from Cancer