Palliative Care

Question 1

t/f palliative care is to hasten or postpone death

Answer 1

false

Question 2

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

Answer 2

true

Question 3

care the relieves symptoms of a disease or disoirder

Answer 3

palliative care

Question 4

specific type of palliative care for people who have 6 months or less to live

Answer 4

hospice care

Question 5

t/f palliative care is appropriate at any stage of serious illness

Answer 5

true

Question 6

what is palliative care approach

Answer 6

• done by all health professionals and lay people
• promotes physical and psychosocial well-being of people
• community and policy

Question 7

what is generalist palliative care

Answer 7

• professionals who have had some training in palliative care
• short term palliative care consult around isolated care needs

Question 8

what is specialist palliative care

Answer 8

• interdisciplinary, full-time team with advanced training

- follow and support patients and families with complex care needs

Question 9

triggers for palliative care referral

Answer 9

• 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

Question 10

domains of palliative care

Answer 10

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

Question 11

components of process and clarification of goals of care

Answer 11

• documentation
• clarification of goals of care
• interdisciplinary team
• emotional support
• continuity of care

Question 12

establishing end of life goals of care

Answer 12

• family meeting

- advance care planning (legal)

Question 13

if estimated life expectancy is months to weeks ___

Answer 13

explore fears about dying and address concerns

Question 14

if estimated life expectancy is weeks to days ___

Answer 14

• clarify and confirm patients and family decisions about life-sustaining treatments, including cpr/dnr
• organ donation

Question 15

total PAIN control

Answer 15

• physical problems must be diagnosed and treated
• anxiety, anger, depression
• interpersonal problems
• not accepting approaching death

Question 16

2 parts of cancer pain

Answer 16

• background pain: persistent pain >/= 12 hours per day

- breakthrough cancer pain: short episode of severe pain, can be predictable or unpredictable

Question 17

in moderate pain, start patients on___

Answer 17

oxycodone and morphine

Question 18

t/f we can reduce opioid dose when bp is going down

Answer 18

false!! give when rr is <8-10/min

Question 19

3 step who analgesic ladder

Answer 19

1: mild pain - use nsaids/acetaminothen +/- adjuvants
2: weak opioids OR nsaids/acetaminophen +/- adjuvants
3: severe and persistent pain - potent opioids +/- nsaids +/- adjuvants

Question 20

t/f patients who were strated on strong opioids had better pain relief than those who were treated according to who guidelines

Answer 20

true, dont use weak opioids anymore for cancer pain

Question 21

protocol for short acting/immediate release morphine and oxycodone

Answer 21

• give q4h during inital opioid titration
• q1h as rescue dose
• CAN BE CRUSHED and given through ngt
• morphine can be giver per rectum

Question 22

protocol for long acting/ controlled release/ slow release oxycodone and morphine

Answer 22

• give q12h as maintenance dose once effective daily dose is determines
• CANNOT BE CRUSHED: enteric coated for slow release

Question 23

drugs that can be given for neuropathic pain

Answer 23

• tramadol
• morphine, oxycodone
• snris
• gabapentin and antidepressants

Question 24

adjuvant analgesics for cancer pain

Answer 24

• bisphosphonates, osteoclasts (bone pain)
• steroids (anorexia and cachexia)
• anteidepressants (neuropathic)

Question 25

t/f administering opioids means administering laxatives

Answer 25

stimulants: senna and bisacodyl

osmotic laxative: lactulose

Question 26

drugs for breathlessness

Answer 26

• oxygen therapy

- opioids: severe pain, severe breathlessness, cough

Question 27

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

Answer 27

true

Question 28

physiology of opioid relief of dyspnea

Answer 28

• dampens abnormally high inspiratory drive in brainstem
• modulates cortical activtiy
• decreases oversensitivity to hypercapnea
• cardiovascular effects
• tolerated without respiratory depression

Question 29

t/f you can give opioids even if the patient has bowel obstruction

Answer 29

true, offer relief first

Question 30

drugs for malignant bowel obstruction

Answer 30

• opioids for pain relief
• corticoteroids
• anti secretory agents to dry up secretions
• decompress if necessary (ngt or peg)
• consider tpn

Question 31

___ cannabinoids are us fda approved for prevention and treatment of chemotherapy induced nausea and vomiting in cancer patients

Answer 31

dronabinol and nabilone

Question 32

doc for cancer cachexia

Answer 32

megestrol acetate and corticosteroids

Question 33

5 stages of grief

Answer 33

denial
anger
bargaining
depression
acceptance

Question 34

the noise heard at end of life due to dying patient’s inability to swallow or cough build-up of saliva blocking the airways

Answer 34

death rattle

Question 35

what is palliative sedation

Answer 35

• not euthanasia, and doesn’t hasen death

- when there are refractory symptoms