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Geriatrics > Palliative Med last lecture > Flashcards

Palliative Med last lecture Flashcards

1
Q

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

A

10% sudden

90% slow

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2
Q

Why are we so valuable at the end of life?

A

Have experience with death

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3
Q

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

A

Time course is unpredictable, and hard to anticipate needs

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4
Q

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

A

Regularly review plan of care

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5
Q

What are our responsibilities for preparing for death?

A

Aware of pts choices
Giving knowledge
Rapid respond

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6
Q

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

A

True

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7
Q

What happens to nutritional intake before death?

A

Decreases

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8
Q

True or false: pts near death are usually lethargic

A

False- usually restless

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9
Q

True or false: pts near death are usually lucid

A

False- altered states of consciousness

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10
Q

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

A

True

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11
Q

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

A

True

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12
Q

What happens to breathing near death?

A

Decreased to apnea for some time

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13
Q

Why does gurling occur near death?

A

Lung secretions not cleared

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14
Q

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

A

True

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15
Q

What happens to the skin near death?

A

Dusky’blotchy

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16
Q

What happens to their level of awareness when death is imminent

A

Little

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17
Q

What happens to the eye near death

A

Stop blinking so much

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18
Q

What is ICHABOD syndrome (near death symptoms)?

A 
Immobility
Confusion
Homeostatic failure
Anorexia
Breathing changes
Oral intake decreased
Dyspnea
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19
Q

Fever near death is caused by what?

A

Failure of hypothalamus to regulate temperature well–NOT infx

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20
Q

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

A

Joint position fatigue
Decubitus ulcers
ADLs

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21
Q

How can anorexia be protective?

A

Risk of aspiration

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22
Q

What are the three ways of saying no to food?

A

Clench teeth
Push away
Say no

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23
Q

What makes food nauseating at the end of life?

A

Low blood flow to GI tract

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24
Q

How do we help the family deal with pt anorexia?

A

Find some other way to nurture the pts

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25
Q

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

A

Absence of hunger
Loss of electrolytes
Decreased GI tract blood flow

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26
Q

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

A

Hunger = stomach

Thirst and taste = mouth

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27
Q

Why are liquids so important?

A

Xerostomia

28
Q

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

A
  • Is pts well being enhanced?

- Aggravation of symptoms

29
Q

True or false; Dehydration does not cause distress

30
Q

What is the MOA of dehydration protection?

A

Releases endorphins

31
Q

How can parental fluids be harmful?

A

Fluid overload

32
Q

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

A

Tachycardia
Peripheral cyanosis
Mottling of skin

33
Q

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

A

True–just makes fluids go where you don’t want them

34
Q

What is the last sensation to be lost during LOC?

35
Q

What happens to breathing with LOC?

A

Changes (rapid to deep).

36
Q

What happens to sphincter control near death?

A

Loss of control

37
Q

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

38
Q

What are the two roads to death?

A

Difficult road = progression to crazy, before szs and coma

Easy = slowly lose consciousness

39
Q

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

A

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

40
Q

True or false: typically, dying is peaceful

41
Q

How do you test for decreasing LOC?

A

Eyelash flick

42
Q

True or false: awareness > ability to respond?

43
Q

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

44
Q

What type of questions should you asking near death pts?

A

Binary (yes or no)

45
Q

How can you increase communication with the unconscious pt?

A
  • Create familiar environment

- assure safety of pt

46
Q

When should family give permission to die?

A

When they mean it

47
Q

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

48
Q

How do you manage terminal delirium?

A

Benzos

Neuroleptics

49
Q

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

A

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

50
Q

What are the changes in respiration? (3)

A

Diminishing tidal volume
Apnea
Chyene-stokes

51
Q

What are the last reflex breaths?

A

Gasping breath after the last

52
Q

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

53
Q

What are the common fears with changes in respiration?

A

Suffocation

54
Q

When can oxygen be helpful? When can it hurt?

A

Comfort for family

Bed if proloning death

55
Q

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

A

Loss of gag reflex

Build up of secretions

56
Q

What is postural drainage?

A

Allowing secretions to drain through positioning

57
Q

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

58
Q

What is the drug of choice to dry secretions?

A

Scopolamine

59
Q

What are the signs of pain?

60
Q

What do you need to distinguish pain from?

A

Terminal delirium

61
Q

When should opioids be decreased?

A

With renal function

62
Q

How should opioids be given near the end of life?

A

Least invasive route

63
Q

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

64
Q

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

65
Q

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

66
Q

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

67
Q

What are the two things you should discuss near death?

A

Status of pt/goals

Role of physician

Geriatrics (30 decks)

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