Palliative care Flashcards
signs and symptoms at the end of life
- pain
- anorexia
- dyspnea
- constipation
- N/V
- fatigue
- delirium
- depression and anxiety
what route is prefered for opioid dosage
- oral route if the aptient cannot tolerate SC
what type of opioid is going to be given for naive patients
- instant release opioids
how do you calculate a breakthrough dose
10% of total daily dose regular medication regime
what should be done if the patient gets more than 5 breakthrough doses in 24 hours
- increase regualr dosage based on 24-72 dosage average
assessment to be done for palliative dyspnea
- rate from 0-10
- OPRSTUAI
- resp assessment
- chest x-ray
- spirometry
- CBc and CHEM 7
nursing interventions to manage palliatiev dyspnea
- identify patient wishes
- calming environment
- positioning
- fan and purse lip breathing
- oxygen therapy
assessment for palliative dysphagia
- oral cavity
- swallowing
- sizing of dentures
- coughing with meals
- pocketing food
interventions to help with palliatiev dysphagia
- thickended fluids
- NG tube or TPN
- sittin up with meals
- awake and alert during meals
- mouth care before and after meal
what can cause palliative delirium
- medication
- metabolic and electrolyte imbalances
- hypoxia
- urinary obstruction
- sleep deprivation and change in environment
assessment of palliative delirium
-
- physical exam
- health hsitory (if possible)
- CAM
- any changes in mental status
- assess CBC. chem7, creatining, urine analysis
nursing intervention for managing palliative delirium
- reverse the cause
- reorient patient
- reduce stimulation
- work together with family and friends
assessment for palliative constipation
- review meds
- what si their mobility status
- bowel assessment
- abdo assessment
- CT scan to look for obstruction
interventions to manage palliative anorexia or cachexia
- explore the patient, concern fear and education
- small frequent meals without forcing
- appetit stimulants
- artificial nutrition or hydration as ordered
what is the psychological assessment for palliative patients
- anxiety symptoms
- depressions creening –> weight loss, changes in sleep, appetite changes
spiritual care assessment for palliative care
- understand their faith and the role it plays in their illness
- FICA
nursing interventions to support spiritual needs
- acknowledge and respect
- acess to spiritual care person
what are signs of imminent death
- withdrawal
- increased sleep
- bed-bound
- diminished food and and fluid intake
- altered breathing
- skin changes
- incontinence
- decreased urine output
- peripheral cyanosis
- absence of radial pulse
- decrease LOC
what is the nurses role when death seems to be immenent
- assessment for signs fo end of life
- docontinuing meds as per orders
- SC meds to releive symptoms
- stop bowel protocls
- discontinue vitals and oxygen
- review their feeding and hydration orders
what is the “honeymoon” period in palliative aptients
- sudden lucidity of the patient where they have increased alertness and an energy surge
what are the four criteria where someone is deemed to be in distress in palliative care
- panic state
- major respiratory distress
- sudden onsent or rapidly increasing intolerable pain
- massive hemorrhage
