palliative care Flashcards
what is palliative care?
-not only about death
-focus remains on “living well” through good symptom management
who is accepted to palliative care?
patients will a life limiting condition and symptom issues
who is on the team
-palliative MD or NP
-nurse
-social worker
-patient
-family
-whoever the patient wants
-PT/OT
-discharge planner
-community health nurse
-family MD or NP
goals of palliative care
-empowering patients to be active participants in their own care
-the team focuses on having recognizable, clear, achievable goals
-determine what patients want to happen
what is a patients performance status
used to for palliative scoring (PPS)
-ability to do self care
-cognitive status
-signs of progressive illness
-ability to cope with aggressive tx
-understanding of normal progression of illness
what happens when palliative care is started late?
-poor symptom control for longer
-poorer QOL
-inappropriate tx and care choices
-lack of prep for EOL by pts and their families
-unrealistic expectations
-increased health care costs
why is it important to share information accurately with clients
-stress for clinician
-changes clinical relationship
-often a key thing pts and families remember
-legal ramifications
-better decision making creates better clinical outcomes
barrier to palliative care
-HCPs fears can be projected. our lack of skill can inhibit us learning more and being open
-perceived reaction of pt
-lack of training/prep/confidence
-feelings of failure/possible legal implications
“SPIKES” format for delivering bad news
S->setting up the interview
P->perception
I->invitation
K->knowledge
E->emotions
S->strategy/summary
promises made by HCP at end of life
-only promise what you can deliver
-effective communication can inc information recall and reassure patient
format to use when calling doctor about symptom management
OLD CART
O-> onset
L-> location
D-> duration
C-> characteristics
A-> alleviating/aggravating
R-> radiating
T-> timing
principles of symptom management
-set achievable goals
-start low and go slow
-use one drug at a time when possible
-try “multi-use” medications
-dispel myths about medication use
differences in pain location
somatic (firm tissues)
visceral (soft tissue)
neuropathic (having nerve involvement)
acute vs chronic pain
acute often has autonomic response “looks like theyre in pain”
in chronic the body adjusts and no autonomic response anymore, patients can look comfortable
what is somatic pain
pain of firm/harm tissues (bone, muscle)
-described as being localized
-tx starts with non opioid pain killers with titration to stronger meds prn
what is visceral pain
pain in soft tissue, generalized in location
-usually relieved with opioids
what is neuropathic pain
pain that originates from the nervous system
-“pins and needles”
-tx with both opioids and adjuvants
-challenging to tx
opioids for pain management in palliative care
-oral is preferred when possible
-opioids may be used as the sole tx or in combination
-should always be used in conjunction with other tx modalities
common adjuvant medications
-NSAIDS for pain
-antidepressants for neuropathic pain
-anticonvulsants for neuropathic pain
-local anesthetics (rare)
-neuroleptics
-steroids
-hormonal agents
-biphosphonates
common adjuvant treatments
-chemo
-radiotherapy
-surgery
-nerve blocls/epidurals
treatment of side effects
-laxatives for constipations
-antinauseants with opioids
-dry mouth
-vivid dreams and halluciantions
dosing schedule for medications
-medications should be ordered regular if PRN doses are need 3/day or more
-breakthrough is prescribed hourly and immediate release
vomiting tx without an order
-hydrate
-oral care
-consider other routes besides PO
-well ventilated environment
-consider constipation
treatment of partial bowel obstruction
-prokinetic agents to push stuff thru the bowel
-antihistamines
-phenothiazine
-steroids to reduce edema
-octreotide as a drying agent
