Palliative Care Flashcards
t/f palliative care is to hasten or postpone death
false
t/f can begin at diagnosis and should be delivered concurrently with disease-directed, life-prolonging therapies and should facilitate patient autonomy, access to information and choice
true
care the relieves symptoms of a disease or disoirder
palliative care
specific type of palliative care for people who have 6 months or less to live
hospice care
t/f palliative care is appropriate at any stage of serious illness
true
what is palliative care approach
- done by all health professionals and lay people
- promotes physical and psychosocial well-being of people
- community and policy
what is generalist palliative care
- professionals who have had some training in palliative care
- short term palliative care consult around isolated care needs
what is specialist palliative care
- interdisciplinary, full-time team with advanced training
- follow and support patients and families with complex care needs
triggers for palliative care referral
- high risk of poor pain management or pain that remains resistant to conventional therapies
- high non-pain symptom burden
- high distress score (>4)
- need for invasive procedures
- frequent er visits/admissions
- need for icu level care
domains of palliative care
domain 1: structure and processes of care
2: physical aspects of care
3: psychological and psychiatric aspects of care
4: social aspects of care
5: spiritual, religious, and existential aspects of care
6: cultural aspects of care
7: care of the imminently dying patient
components of process and clarification of goals of care
- documentation
- clarification of goals of care
- interdisciplinary team
- emotional support
- continuity of care
establishing end of life goals of care
- family meeting
- advance care planning (legal)
if estimated life expectancy is months to weeks ___
explore fears about dying and address concerns
if estimated life expectancy is weeks to days ___
- clarify and confirm patients and family decisions about life-sustaining treatments, including cpr/dnr
- organ donation
total PAIN control
- physical problems must be diagnosed and treated
- anxiety, anger, depression
- interpersonal problems
- not accepting approaching death
2 parts of cancer pain
- background pain: persistent pain >/= 12 hours per day
- breakthrough cancer pain: short episode of severe pain, can be predictable or unpredictable
in moderate pain, start patients on___
oxycodone and morphine
t/f we can reduce opioid dose when bp is going down
false!! give when rr is <8-10/min
3 step who analgesic ladder
1: mild pain - use nsaids/acetaminothen +/- adjuvants
2: weak opioids OR nsaids/acetaminophen +/- adjuvants
3: severe and persistent pain - potent opioids +/- nsaids +/- adjuvants
t/f patients who were strated on strong opioids had better pain relief than those who were treated according to who guidelines
true, dont use weak opioids anymore for cancer pain
protocol for short acting/immediate release morphine and oxycodone
- give q4h during inital opioid titration
- q1h as rescue dose
- CAN BE CRUSHED and given through ngt
- morphine can be giver per rectum
protocol for long acting/ controlled release/ slow release oxycodone and morphine
- give q12h as maintenance dose once effective daily dose is determines
- CANNOT BE CRUSHED: enteric coated for slow release
drugs that can be given for neuropathic pain
- tramadol
- morphine, oxycodone
- snris
- gabapentin and antidepressants
adjuvant analgesics for cancer pain
- bisphosphonates, osteoclasts (bone pain)
- steroids (anorexia and cachexia)
- anteidepressants (neuropathic)
t/f administering opioids means administering laxatives
stimulants: senna and bisacodyl
osmotic laxative: lactulose
drugs for breathlessness
- oxygen therapy
- opioids: severe pain, severe breathlessness, cough
t/f opioids can be used in opioid naive and tolerant pts without causing relevant breath depression or impaired oxygenation or increase in co2 concentration
true
physiology of opioid relief of dyspnea
- dampens abnormally high inspiratory drive in brainstem
- modulates cortical activtiy
- decreases oversensitivity to hypercapnea
- cardiovascular effects
- tolerated without respiratory depression
t/f you can give opioids even if the patient has bowel obstruction
true, offer relief first
drugs for malignant bowel obstruction
- opioids for pain relief
- corticoteroids
- anti secretory agents to dry up secretions
- decompress if necessary (ngt or peg)
- consider tpn
___ cannabinoids are us fda approved for prevention and treatment of chemotherapy induced nausea and vomiting in cancer patients
dronabinol and nabilone
doc for cancer cachexia
megestrol acetate and corticosteroids
5 stages of grief
denial anger bargaining depression acceptance
the noise heard at end of life due to dying patient’s inability to swallow or cough build-up of saliva blocking the airways
death rattle
what is palliative sedation
- not euthanasia, and doesn’t hasen death
- when there are refractory symptoms
