1. who i want to make decisions 2. what treatment i want 3. how comfortable 4. how i want to be treated 5. what i want my loved ones to know

Palliative Care Flashcards by Ruby Trella

characteristics of hospice

neither prolongs or hastens death
improve quality of patient’s last days
care is delivered by an interprofessional team using a holistic approach
must forgo curative treatment
medical prognosis of 6 months or less

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EOL care domains

patient & family-centered decision making
communication
continuity of care
emotional and practical support
symptom management and comfort care
spiritual support
emotional and organizational support for clinicians

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POLST

provider order for life-sustaining treatment
CPR or AND
full code or modified
medically assisted nutrition

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common symptoms at EOL

pain
fatigue/weakness
GI: anorexia, cachexia, N/V/D, constipation, dysphagia
respiratory: dyspnea, cough
Skin: pruritus, sweats, wounds
Psychological: anxiety, depression, delirium
lymphedema, insomnia

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5 wishes

who i want to make decisions
what treatment i want
how comfortable
how i want to be treated
what i want my loved ones to know

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legacy making

am i important in this life?
did my life make a difference?
will i be remembered?
what will i be remembered for?
making memories
reminiscence therapy
storytelling

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4 symptom management outcome

physical well-being: symptoms
social: social support, relationships
psychological: anxiety, depression
spiritual: values & beliefs, meaning & purpose

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general symptom assessment using multidimensional approach

body: physiologic, sensory
mind: emotional, cognitive, behavioral
spirit: meaning, purpose

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Tier 1 of Tiered Approach to Symptom Management

mind-body therapies
nutritional therapies
natural products
supplements
integrative nursing therapies

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tier 2 of Tiered Approach to Symptom Management

movement therapies
nutritional therapies
natural products and herbs

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tier 3 of Tiered Approach to Symptom Management

mind-body therapies
energy therapies
health coaching
manipulative therapies

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tier 4 of Tiered Approach to Symptom Management

whole systems (like CM)

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tier 5 of Tiered Approach to Symptom Management

pharmacological therapies
psychotherapy/behavioral therapy
other invasive therapies

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symptoms associated with pain

constipation
fatigue
nausea
fear
anxiety
urinary retention
ineffective breathing pattern

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factors of pain management in older adults

physiological changes: pain perception, organ function decline
pain experience: history, chronic illness
psychological factors: fear of addiction/complainer, anxiety, depression
comorbidities
polypharmacy
geriatric syndromes: delirium, falls
impact of pain on ADLs and iADLs
perception that pain is normal

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barriers to pain management

fear of addiction
tolerance to opioids
failure of staff to assess & document pain
lack of access to adequate treatment
view pain as expected r/t disease
lack of administration of appropriate analgesics
inadequate knowledge about pain management
legal issues

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tolerance

larger doses are needed over time to produce the same analgesic effect

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physical dependence

continued drug use is required to prevent withdrawal symptoms

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addiction

behavior pattern which demonstrates the psychological need for opioid

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types of pain

HA d/t ICP
acute spinal cord compression
SVC syndrome
metastatic bone pain
arthritic pain (RA)
pain d/t organ enlargement

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therapeutic effects of corticosteroids

anti-inflammatory, increases appetite, elevates mood, suppresses nausea

side effects of corticosteroids

oral candidiasis, edema, Cushingoid syndrome, dyspepsia, water weight gain, ecchymoses, hyperglycemia, myopathy, neuropsych changes

bladder spasm pain meds

oxybutynin
prostaglandins

rectal spasm pain meds

diltiazem
clonidine
benzodiazepines (lorazepam)

meds for colicky pain d/t bowel obstruction

scopalamine octrotide

bone pain meds

NSAIDs: acetaminophen, aspirin, naprozen, ibuprofen, ketoprofen, keterolac corticosteroids biphosphonates

neuropathic pain characteristics

numbness, tingling, pins, needles lancinating, shooting, shock-like

neuropathic pain meds

antidepressants: tertiary amine tricyclic and secondary amine tricyclic drugs anticonvulsants: carbamazepam, gabapentin long-term systemic local anesthetic topical anesthetic clonidine, baclofen, calcitonin, ketamine, clonazepam

symptoms associated with pain management by opioids

circulatory depression urinary retention cutaneous effects: pruritus, flushing, sweating respiratory depression

fatigue

overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work tired, lack of energy, exhausted, heavy, slow

fatigue etiology

chronic, unrelieved symptoms treatment-related infection malnutrition endocrine disorders (Hypothyroidism) anemia sleep pattern disruption/poor sleep quality

nausea and vomiting etiology

anorexia constipation d/t decreased motility spicy, unusual foods dehydration abdominal pain d/t bowel obstruction meds: opioids, anti-infectives, chemotherapy d/t stimulation of CRTZ and VC

constipation etiology

altered propulsion of contents, increased adsorption, decreased secretion, medications that decrease peristalsis

constipation prevention

stool softeners/laxatives, fiber, hydration, exercise, routine toileting

dyspnea etiology

narrowing of airways d/t bronchial constriction from swelling, tumor invasion or decreased alveolar function d/t fluid retention, tumor invasion COPD, asthma cancer cardiopulmonary disease

dyspnea manifestations

SOB, increased RR, gasping, wheezing, gurgling tripod positioning intercostal retraction orthopnea

dyspnea treatment

fanning/moving air, slow rhythmic breathing, pursed lip breathing bronchodilators: albuterol, atrovent corticosteroids: prednisone opioid therapy: morphine

pruritus etiology

cancer-related polycythemia vera renal and hepatic disease allergic reaction dehydration, dry environment medications (opioids, anti-infectives)

pruritus symptoms

severe itching, burning, numbness/tingling

nonpharmacologic treatment of pruritus

humidifier, cool room temp, fans/moving air cotton/loose clothing hypoallergenic soap avoid alcohol and spicy foods hydration keep skin lubricated

pharmacologic treatment of pruritus

diphenhydramine h2 receptor antagonist (ranitidine, cimetidine) doxepin (TCA) serotonin antagonist (ondansetron)

delirium

non-specific cerebral dysfunction and LOC changes, thinking, memory, attention, & emotional disturbances; develops over short time 50% reversible

delirium etiology

meds (opioids, benzos) hypoxia dehydration metabolic (hypercalcemia, hyponatremia) sepsis polypharmacy ICP

delirium assessment

CAM-ICU

delirium treatment

treat reversible causes: change opioids, hydration, oxygen, bronchodilators, decrease number of meds neuroleptics: haloperidol to manage agitation and hallucinations benzodiazepines: lorazepam, midazolam corticosteroids: manage cerebral swelling

neurological indicators of imminent death

decreased verbal response, agitation, restlessness

cardiac indicators of imminent death

increased/irregular HR decreased BP widening pulse pressure dehydration

pulmonary indicators of imminent death

increased RR dyspnea increased use of accessory muscles Cheyne-Stokes respirations noisy breathing

GI indicators of imminent death

stool incontinence nausea

renal indicators of imminent death

urinary incontinence decreased urine output

mobility

limited bedridden needs frequent position changes

stages of dying (loss) Kubler-Ross

1. denial 2. anger 3. bargaining 4. depression 5. acceptance