Palliative Med last lecture

Question 1

What is the split (%) between sudden vs slow death?

Answer 1

10% sudden

90% slow

Question 2

Why are we so valuable at the end of life?

Answer 2

Have experience with death

Question 3

What makes preparing for the last hours of life difficult? (2)

Answer 3

Time course is unpredictable, and hard to anticipate needs

Question 4

What should do if the patient wants to die at home?

Answer 4

Regularly review plan of care

Question 5

What are our responsibilities for preparing for death?

Answer 5

Aware of pts choices
Giving knowledge
Rapid respond

Question 6

True or false: there is less interesting in communication with the world near the end of life

Answer 6

True

Question 7

What happens to nutritional intake before death?

Answer 7

Decreases

Question 8

True or false: pts near death are usually lethargic

Answer 8

False- usually restless

Question 9

True or false: pts near death are usually lucid

Answer 9

False- altered states of consciousness

Question 10

True or false: pts are usually quiet and reflective near the end of death

Answer 10

True

Question 11

True or false: sleeping and waking hours are often messed up near death

Answer 11

True

Question 12

What happens to breathing near death?

Answer 12

Decreased to apnea for some time

Question 13

Why does gurling occur near death?

Answer 13

Lung secretions not cleared

Question 14

True or false: a surge of energy can occur just prior to death

Answer 14

True

Question 15

What happens to the skin near death?

Answer 15

Dusky’blotchy

Question 16

What happens to their level of awareness when death is imminent

Answer 16

Little

Question 17

What happens to the eye near death

Answer 17

Stop blinking so much

Question 18

What is ICHABOD syndrome (near death symptoms)?

Answer 18

Immobility
Confusion
Homeostatic failure
Anorexia
Breathing changes
Oral intake decreased
Dyspnea

Question 19

Fever near death is caused by what?

Answer 19

Failure of hypothalamus to regulate temperature well–NOT infx

Question 20

Why do we care about immobility in the near death pts (besides emboli)?

Answer 20

Joint position fatigue
Decubitus ulcers
ADLs

Question 21

How can anorexia be protective?

Answer 21

Risk of aspiration

Question 22

What are the three ways of saying no to food?

Answer 22

Clench teeth
Push away
Say no

Question 23

What makes food nauseating at the end of life?

Answer 23

Low blood flow to GI tract

Question 24

How do we help the family deal with pt anorexia?

Answer 24

Find some other way to nurture the pts

Question 25

What is the difference between body shutting down and starvation? (3)

Answer 25

Absence of hunger Loss of electrolytes Decreased GI tract blood flow

Question 26

Where is the locus of sensation of thirst, taste and hunger?

Answer 26

Hunger = stomach | Thirst and taste = mouth

Question 27

Why are liquids so important?

Answer 27

Xerostomia

Question 28

What are the questions that should be asked with artificial hydration?

Answer 28

- Is pts well being enhanced? | - Aggravation of symptoms

Question 29

True or false; Dehydration does not cause distress

Answer 29

True

Question 30

What is the MOA of dehydration protection?

Answer 30

Releases endorphins

Question 31

How can parental fluids be harmful?

Answer 31

Fluid overload

Question 32

What is the first sign of decreasing blood perfusion? Two others?

Answer 32

Tachycardia Peripheral cyanosis Mottling of skin

Question 33

True or false: parental fluids do not reverse decreasing blood perfusion

Answer 33

True--just makes fluids go where you don't want them

Question 34

What is the last sensation to be lost during LOC?

Answer 34

Hearing

Question 35

What happens to breathing with LOC?

Answer 35

Changes (rapid to deep).

Question 36

What happens to sphincter control near death?

Answer 36

Loss of control

Question 37

True or false: periods of apnea come and go near death

Answer 37

True

Question 38

What are the two roads to death?

Answer 38

Difficult road = progression to crazy, before szs and coma Easy = slowly lose consciousness

Question 39

True or false: drs do not be a part of the road to death

Answer 39

Not if there's nurses or other ppl to provide info

Question 40

True or false: typically, dying is peaceful

Answer 40

True

Question 41

How do you test for decreasing LOC?

Answer 41

Eyelash flick

Question 42

True or false: awareness > ability to respond?

Answer 42

True

Question 43

True or false: you should assume that the pt hears everything

Answer 43

True

Question 44

What type of questions should you asking near death pts?

Answer 44

Binary (yes or no)

Question 45

How can you increase communication with the unconscious pt?

Answer 45

- Create familiar environment | - assure safety of pt

Question 46

When should family give permission to die?

Answer 46

When they mean it

Question 47

True or false: pts near death have a heightened bullshit radar

Answer 47

True

Question 48

How do you manage terminal delirium?

Answer 48

Benzos | Neuroleptics

Question 49

What is the drug of choice for seizures in the dying pts? Why?

Answer 49

Valium--does not stop szs, just stops tonic-clonic movement

Question 50

What are the changes in respiration? (3)

Answer 50

Diminishing tidal volume Apnea Chyene-stokes

Question 51

What are the last reflex breaths?

Answer 51

Gasping breath after the last

Question 52

Are accessory muscles used often or less so at the end?

Answer 52

More

Question 53

What are the common fears with changes in respiration?

Answer 53

Suffocation

Question 54

When can oxygen be helpful? When can it hurt?

Answer 54

Comfort for family | Bed if proloning death

Question 55

What happens to swallowing near the end of death? (2)

Answer 55

Loss of gag reflex | Build up of secretions

Question 56

What is postural drainage?

Answer 56

Allowing secretions to drain through positioning

Question 57

True or false: suctioning is often indicated to control secretions near death

Answer 57

False

Question 58

What is the drug of choice to dry secretions?

Answer 58

Scopolamine

Question 59

What are the signs of pain?

Answer 59

Grimacing

Question 60

What do you need to distinguish pain from?

Answer 60

Terminal delirium

Question 61

When should opioids be decreased?

Answer 61

With renal function

Question 62

How should opioids be given near the end of life?

Answer 62

Least invasive route

Question 63

True or false: pads for drug admin is useful at the end of life

Answer 63

False

Question 64

True or false: IM routes should be avoided at the end of life

Answer 64

True

Question 65

True or false: you should still give all usual meds near end of life to ensure routine

Answer 65

False

Question 66

True or false: what the pt experiences is not the same as what onlookers see

Answer 66

True

Question 67

What are the two things you should discuss near death?

Answer 67

Status of pt/goals | Role of physician