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155 Selected Conditions > palliative & end of life care > Flashcards

palliative & end of life care Flashcards

1
Q

difference between conventional, and complementary and alternative medicine (CAM); what happens when you put together conventional w CAM therapies

A

conventional = healthcare system (MD, OD, PTs, psychs, nurses, etc)
CAM = adjuncts; stuff that might have proven/questionable evidence for their use
- complementary = additional
- alternative = in place

integrative medicine

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2
Q

other terms for conventional medicines

A

western/allopathic

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3
Q

chemo vs rad therapy

A

chemo - delivered intravenously; systemic treatment that targets rapidly dividing cells (hallmark of cancer cells) but it also affects other rapidly dividing cells throughout the body (e.g., hair follicles, GI tract, bone marrow); metastasized cell
rad therapy - radiation focused on a specific area in the body; mostly has side-effects for region/s near cancer cell site; for cancer cells that havent metastasized, earlier stages of cancer

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4
Q

if experiencing: anxiety
consider trying:

A

hypnosis, massage, meditation, music therapy, relaxation techniques

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5
Q

(integrative med)
if experiencing: fatigue
consider trying:

A

exercise, massage, relaxation techniques, yoga

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6
Q

(integrative med)
if experiencing: nausea and vomiting
consider trying:

A

acupuncture, aromatherapy, music therapy, hypnosis

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7
Q

(integrative med)
if experiencing: pain
consider trying:

A

acupuncture, aromatherapy, music therapy, hypnosis, massage

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8
Q

(integrative med)
if experiencing: sleep problems
consider trying:

A

CBT, exercise, yoga, relaxation technique

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9
Q

(integrative med)
if experiencing: stress
consider trying:

A

aromatherapy, tai chi, yoga, relaxation techniques, meditation, exercise, massage, hypnosis, music therapy

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10
Q

difference of palliative care and hospice

A

palliative care = supportive care; may help with effects from condition and/or treatment; multidisciplinary symptom mgmt (esp. prescribed for conditions w great sx. burden)
hospice care = end-of-life care, focused on comfort and raising pt.’s QoL rather than extending life

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11
Q

compression of morbidity types describe

A

what it is - what it does for the pt.
1. present morbidity
- gets sick + no intervention; disease will run its course
2. life extension
- with current medical options, life is extended; pt. also carries the disease for longer
3. shift to the right
- pt. practices healthy habits when they were younger (e.g., good diet, exercise) so start of disease shifts to right/starts later in life, and they live a longer life
4. compression of morbidity
- sickness starts relatively later bc of healthy habits but pt. opts for natural course of disease = aka dying earlier but better QoL

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12
Q

when does palliative care start

A

it can start along with diagnosis and treatment

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13
Q

hospice duration

A

~6mos or less -> death
can still get hospice tx even if you have years left to live

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14
Q

bereavement

A

period after death

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15
Q

describe the multidimensional nature of pain (what other dimensions/disciplines are involved during care?)

A

physical, social, psychological, spiritual

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16
Q

[EXAM] types of pain and differentiate

A

nociceptive - nociceptive stimuli; source can usually be identified (fully relieved by narcotics/analgesics)
- somatic
- can usually be localized; tends to originate from superficial nociceptors
- visceral
- inflammation; hard to localize but there is a reference area, diffuse discomfort

neuropathic pain - associated with issues in CNS (chronic pain = central sensitization)
- nerve damage symptoms (sensory/motor impairments)
- only partially relieved by narcotics; anticonvulsants/depressants may be indicated depending on pain severity

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17
Q

levels of pharmacological interventions and their characteristics

A

1: MILD (non-opioid)
- acetaminophen, NSAIDs
- VRS = 1-3/10
2: MODERATE (opioid)
- addictive; only given for moderate-severe pain
- VRS = 4-6/10
3: SEVERE (opioid)
- VRS = 7-10/10
* adjuvant
- analgesics; usually target different dimensions of pain (e.g., comorbidities)
- antidepressants, anticonvulsants, corticosteroids, local anesthetics, and calcium channel blockers

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18
Q

palliative sedation mechanism and effects

A

given when terminally ill patients suffer from intractable or unendurable pain and management measures have little to no affect in alleviating the pain experience
- using sedatives to induce reduced levels of consciousness so that pt. experiences less pain
- side effect is that: the more pt is sedated, the more their respiratory system is depressed; eventually this leads to death

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19
Q

describe the line of morbidity, disability, and mortality

A

morbidity occurs first, followed by disability, ends in mortality ; d/t new technology the distance between morbidity and mortality is increasing bc there are more life-prolonging procedures

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20
Q

the ethical issue behind life-prolonging procedures

A

do these procedures prolong life and maintain QoL or do they just delay death?

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21
Q

good death concept (3 things)

A
  • comfortable / free of discomfort
  • around family
  • in the environment you want
22
Q

(focus, what is it not?) hospice care

A

cure, not care
often done at home or in nursing home

23
Q

interdisciplinary hospice care team

A

physician, nurses, consultative professionals (PTs here), chaplains/spiritual leader, volunteers, home health aides, social workers/psychs

24
Q

what do PTs do in hospice care? (3) give examples

A
  1. reduce pain
  2. optimize/improve remaining function
  3. enhance QoL

ex.: modalities, improve sleep and respiratory fx., reduce need for analgesics; energy efficiency/conservation pt educ. for pt. and family

25
Q

models of therapy

A

rehab light
- performing light exercises while not depleting energy

rehab in reverse
- pt. gets progressively weaker so rehab activities get progressively lighter to accommodate decreasing ability

case management
- working with interdisciplinary hospice care team

26
Q

specific tactics that PT can do in hospice care

A
  1. comfort care measures
    - MLD to prevent edema
    - therapeutic techniques (neurodevelopmental techniques; e.g., holding, rocking) to provide comfort
    - ROM exercises to optimize movement
    - pt. education regarding falls prevention (physically ability vs wanting to get out of bed)
    - non pharm measures for pain mgmt (rocking, tens)
  2. adaptive equipment and environment
    - optimize environment to help with movement (e.g., trapeze, bedside commode)
    - energy conservation techniques
  3. exercise - to achieve functional goals, not just a way to spend time
27
Q

describe progressive changes in terminal phase

A

month 6
- fxn is kinda fine; can ambulate, had some side effects from curative tx
- denial, anger

month 5
- physical weakness and weight loss
- depression & anxiety

month 4
- body is starting to fail
- loss of appetite
- hospice provides counselors to help w process

month 3
- beginning to withdraw
- pt. accepts theyre going to die/terminal disease

month 2
- increasing withdrawal
- sx. and pain increase
- may be bedridden at this point

month 1
- no appetite, care relies entirely on caregivers
- completely withdrawn; only close loved ones can interact w them

28
Q

pain at the end of life

A

the main focus of hospice care process is to make sure there is as little pain as possible towards the end of life; comfort measures for pain mgmt, eventually palliative sedation that leads to death

29
Q

other s&s at end-of-life (3)

A

delirium, fever, dryness of eyes and lips

30
Q

delirium

A

MOST COMMON neuropsychiatric condition at the end of life
- global CEREBRAL dysfunction: disordered attention, awareness, cognition; may see visions
- stressful for pt. and caregivers
- seeing visions of dead family members
- difficult to initiate meaningful interaction

31
Q

fever

A
  • source isn’t looked for; invasive procedures are avoided bc comfort measures are focused on (pt.’s body may be adversely affected by getting culture samples)
  • may be d/t chemo/rad therapy or infection
  • measures to manage sx.
32
Q

dryness of eyes and lips

A
  • eyewash , viscine
  • mouthwash
33
Q

as the distance between morbidity and mortality grows,

A

it begs the question of prolonging life or delaying death; because would you rather a violent death, a “longer life” stuck in a hospital, or a death at home surrounded by loved ones?

34
Q

legal and ethical issues in end of life care

A

1: right to die
2. palliative sedation
3. CV implants
4. advanced directives

35
Q

right to die/self-determination

A
  • physician aid in dying (PAD) or assisted euthanasia; giving pt. injection/certain amount of drugs (md provides means for pt to kill themselves)
36
Q

palliative sedation

A

different from assisted euthanasia; palliative sedation is to alleviate pain, its effects however can lead to death while euthanasia is done to kill the pt. because they want to

37
Q

CV implants

A

ex. pacemaker
- pt.’s choice if they want to stop it or have a directive to cut the machine at a certain point
- autonomy vs. non-maleficence/beneficence
- respecting the pt. free will or doing no harm

38
Q

advanced directives

A
  • pt.s can make this while theyre still alive
  • living will, DNR/DNAR, DPOA, organ donor card, etc.
  • living will: made before pt dies with instructions on what to do after their death
  • dpoa (durable power of attorney): made before death with power to a representative/s for decision-making on what to do after pt. dies
39
Q

circumstantial vs developmental loss

A

circumstantial loss
- happens out of nowhere; e.g., sudden death, fire, divorce, etc.

dev’tal loss
- comes with expected milestones/stage in life; e.g., kids moving out, retirement, death

40
Q

stages of grief (pioneer of model and stages)

A

elisabeth kubler-ross
DABDA
- denial, anger, bargaining, depression, acceptance

41
Q

“keen mental suffering or distress over affliction or loss; sharp sorrow; painful regret” (Random House, 2017)

A

grief

42
Q

difference between clinical death, brain death, and persistent vegetative state

A

clinical death
- heart stops beating, lungs stop oxygenating blood

brain death
- 3 signs: coma, apnea, absence of brainstem reflexes

persistent vegetative state
- complex processes are absent and they can’t survive without life support but primal functions (e.g., breathing, blinking, swallowing) are present

43
Q

what are the last hours of life called; duration

A

active dying - 24 hours

44
Q

s&s when death is near

A

Pain
Delirium
Anxiety/restlessness
Dysphagia
Weakness/fatigue
Dyspnea
Myoclonus
Pressure injuries
Incontinence
Anorexia/nausea/vomiting

45
Q

Arnold van Gennep, French folklorist, - model on rites of passage

A

separation -> transition, reintegration

46
Q

steps for coping with grief (6)

A

Recognition of loss
Reaction to the loss (grief, sadness)
Recollection of deceased and memories
Relinquishing of ties/attachment
Readjustment of relationships, roles, etc bc deceased is gone
Reinvesting into new relationships, experiences

47
Q

purpose of rites of passage (4)

A
  • provide social support
  • restore bereaved to society
  • outline cultural obligations
  • set limitations to formal mourning

rituals help with transition

48
Q

“last offices” or “laying out”

A

preparing the body before mortician gets; nurses usually do this

49
Q

complicated grief (DSM-V)

A
  • prolonged grief (6+ months)
  • intense longing or yearning for the deceased
  • struggle with everyday tasks, form meaningful connections, etc.
  • recurrent intrusive and distressing thoughts
50
Q

risk factors for complicated grief

A
  • sudden, pediatric, violent/MVA death
  • disenfranchised mourners
  • low socioeconomic status
  • existing depression/anxiety
  • death away from loved ones
51
Q

personal grief (as health professionals)

A

Professional loneliness
Loss of professional meaning
Cynicism
Helplessness
Hopelessness
Frustration
Anger
Depression
Burnout

52
Q

coping mechanisms for personal grief

A

prayer/meditation, exercise, writing, calling to family members/other clinicians, attending funerals and memorials

155 Selected Conditions (5 decks)

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