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Pediatrics > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

True or False: Child must be terminally ill or at the end of life for palliative care

A

False

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2
Q

True or false: Child must have a DNR to have hospice care

A

False

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3
Q

True or false: child must abandon all disease directed treatment to receive palliative care

A

False

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4
Q

True or false: child must abandon primary care team and movie to a different unit for palliative care

A

False

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5
Q

True or False: Administering opioids causes respiratory depression and quickens death

A

False

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6
Q

What is the consequence of mislabelling in palliative care?

A

the CARE is palliative not the patient

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7
Q

What do consequences of myths foster:

A

Doing nothing, leading to feelings of giving up, losing hope, last resort

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8
Q

WHO definition of palliative care

A

an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

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9
Q

Pediatric Palliative Care Definition

A

for those 17 minus a day

o A combination of active and compassionate therapies to comfort and support children and families living with a life threatening/limiting illness

o To provide a framework for discussion of balancing the benefits and risks of any intervention

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10
Q

What are life threatening/limiting illnesses

A

Conditions where survival into adulthood is a challenges

Malignancies, respiratory, CNS degeneration/abnormalities, syndromes, CV, neuromuscular, metabolic, transplants

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11
Q

Old palliative care paradigm

A
  • clear demarcation between curative and palliative
  • palliative when close to death
  • little bereavement > only involved at end of life
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12
Q

New palliative care model

A
  • no demarcation between curative and palliative
  • benefit long before death
  • involvement throughout care and extends beyond death
  • care in the home
  • encompasses family
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13
Q

Benefit of early involvement of palliative care

A

for symptom management and decreases feeling of stress when increased services are necessary.

Less stress when they know ahead of time/before end of life care is necessary

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14
Q

Keys to good palliative care

A

Effective communication and impeccable planning

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15
Q

How does disease trajectory in pediatric palliative effect care?

A

often means support for years – diagnosis at birth causes palliative to follow into adulthood

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16
Q

What considerations are made for familial life limiting illnesses?

A

some families have to go through this more than one time and make decisions re limiting family (future children) – autosomal diseases

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17
Q

What do families want from palliative care?

A
  1. positive consistent relationships with caregivers/care team
  2. comprehensive information from familiar staff
  3. adequate pain management
  4. contact after the child’s death
  5. cultural awareness
  6. support for siblings
  7. care in setting of choice
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18
Q

What symptoms are mainly managed in palliative?

A
  1. pain
  2. dyspnea
  3. bleeding
  4. N/V
  5. secretions
  6. constipation/obstruction
  7. fatigue
  8. seizures
  9. irritability/agitation
  10. decreased appetite
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19
Q

4 difficult decisions in palliative care

A
  1. goals of care: what do parents want if child stops breathing
  2. resuscitation guidelines
  3. withdrawal of artificial support
  4. ethical decisions
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20
Q

3 criteria for withdrawal of artificial support

A
  1. imminent death
  2. brain death
  3. child with no small bowel
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21
Q

True or false: resuscitation guidelines are set in stone

A

False

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22
Q

What is important in providing parents guidance on resuscitation guidelines

A

Assure understanding of prognosis and that regardless of interventions, outcome is the same. What differs is the interventions/how we get to the outcome regardless of choice

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23
Q

In saskatchewan, we see the highest incidence per capita of

A

Perinatal palliative care

24
Q

What is the perinatal period?

A

20th/28th week gestation to 1-4 weeks postnatal

25
Q

Describe the patient population for perinatal care?

A
  1. limit of viability: 22-23 weeks around 500g
  2. overwhelming illness unresponsive to treatment or suffering from the treatment
  3. congenital anomies of life-threatening nature
26
Q

What is the birth plan for perinatal palliative care?

A

“Wish List” – location of delivery (close to home?), resuscitation, DNR, symptom management (pain, agitation, seizures, hypoxia)

27
Q

Define pain

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

28
Q

Nociceptive Pain and types

A

Damage to underlying soft and bone tissues by disease

somatic or visceral

29
Q

Description of somatic pain

A
  • Well localized
  • Sharp, throbbing, squeezing or aching
30
Q

Description of visceral Pain

A
  • Diffuse, poorly localized
  • Dull, crampy or colicky
31
Q

Neuropathic Pain

A

o Invasion of or traction on nerves arising from injury to:
 Central Nervous System
 Peripheral Nervous System

32
Q

Description and examples of neuropathic pain

A
  • Burning, stinging, tingling, prickly
  • Stabbing, lancinating, shock-like
  • Ex: tumors, phantom pain, referred pain
33
Q

What is the CRIES assessment tool?

A

Neonatal post-op pain

34
Q

Score indication of CRIES tool

A

< 4 = initiate nonpharmacologic measures

> 4 = initiate pharmacologic and nonpharmacologic measures

35
Q

What 5 things does the CRIES tool assess?

A

Crying, oxygen, vitals, expression, sleeplessness

36
Q

What is the FLACC scale?

A

Post op pain assessment for 2-7 year old

37
Q

What 5 things does the FLACC scale assess

A

Face, legs, activity, cry and consolability scale

38
Q

When would you use the FLACC scale

A

Assesses behaviour -
You would use this scale with patients who have difficulty verbalizing pain

39
Q

3 Limitations of Pain Assessment Tools

A
  1. Only assess behaviour, not fear or anxiety that children combine with pain
  2. self report of child
  3. not holistic assessment of emotional, psychological, spiritual pain
40
Q

Describe the WHO Pain Management Ladder

A

Pt presents w pain

  1. Non opioid +/- adjuvant

Pain persists/increases

  1. Opioid for mild/moderate pain +/- non opioid +/- adjuvant

Pain persists/increases

  1. Opioid for moderate/severe pain +/- non-opioid +/- adjuvant
41
Q

True or false: if a patient comes in with severe pain, according to WHO ladder you begin with non opioid +/- adjuvant

A

False - You do not need to go up each step. If a patient presents with severe pain, you should not treat them on step 1.

42
Q

Pain Management “by the ladder”

A

utilize WHO ladder

43
Q

Pain Management “by the clock”

A

(scheduling something regularly, usually q4h with breakthrough)

44
Q

Pain Management “by the mouth”

A

(start with PO, least invasive first)

45
Q

Pain Management “by the child”

A

(assessing patient not parent)

46
Q

Describe pediatric palliative pain management dosing

A
  • started at standard pediatric dose and titrated for pain from there
  • no expected ceiling or cap on doses
  • The key to this is close communication
47
Q

Opioid side effects

A
  • Constipation
  • Nausea/Vomiting
  • Pruritus
  • Respiratory Depression
  • Confusion and/or Hallucinations
  • Myoclonus: build up of morphine
  • Somnolence: common, wears off in 24-48 hours
48
Q

In what 3 instances should you consult palliative care?

A
  1. life threatening/limiting illness at any age or with any diagnosis
  2. consideration of forgoing life saving therapy
  3. early involvement is crucial
49
Q

How is dyspnea managed in palliative?

A
  • fan
  • upright position
  • opening window
  • O2 dependent on insurance
  • ativan
  • midazolam
50
Q

How is bleeding managed in palliative?

A
  • dark linen and midazolam
51
Q

How is nausea and vomiting managed in palliative?

A
  • small meals
  • hydration
  • nabilone
  • alternate routes for meals
  • decradon, onasetron, metoclopramide
52
Q

How are secretions managed in palliative?

A
  • suction
  • scopalomine patch
  • glycopyrotate
  • mouth care
53
Q

how is constipation managed in palliative

A
  • laxatives/supps
  • miralax
54
Q

How is fatigue managed in palliative

A
  • methylphenidate for older
  • scheduling visits accordingly
55
Q

How is decreased appetite managed in palliative

A
  • small frequent meals
  • awareness patient may choose not to eat
  • megace
56
Q

Most common interventions for perinatal palliative care

A

Tube feeding

Pain usually not an issue but codeine can be prescribed for dyspnea and agitation

Pediatrics (12 decks)

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