Week 10&11 Flashcards
1
Q
Palliative Care
A
An approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness.
2
Q
Transition to Palliative Care
A
- Introducing palliative care focus early in the disease trajectory has better outcomes
- Goal is to relieve symptoms and improve QoL in situations where the underlying disease can’t be cured
3
Q
Palliative Care Domains
A
- Disease management
- Physical, psychological, social, spiritual needs
- Practical needs
- Loss & grief
- End of life/death management
4
Q
Barriers to Palliative Care
A
- Age
- Racial/ethnic group
- Indigenous
- Homelessness
5
Q
Advanced Care Planning
A
- Confirm SDM & prepare for future decision making
- Focus on important to person
- Not consent for future care
6
Q
Goals of Care Discussion
A
- Context of illness
- Values & goals
- Align treatment options with goals
7
Q
Consent for Treatment/Care
A
- Conversation with person/SDM before anything
- SDM acts if person cannot
8
Q
MAID
A
- Cancer most cited underlying condition
- Average age 77
- Typically received palliative care
9
Q
MAID Application
A
- Meet eligibility criteria
- Written request with 2 witnesses
- Assessed by 2 practitioners
- Minimum 10 day reflection period
- Capacity determined & consented obtained prior to procedure
10
Q
MAID Criteria
A
- Eligible for health services funded by federal , provincial or territorial governments
- At least 18 years old and mentally competent (capable of making health care decisions for themselves)
- Have agrievous and irremediable medical condition
- Voluntary request for MAID that is not the result of outside pressure or influence
- Giveinformed consent to receive MAID
11
Q
Conscientious Objection
A
- The law does not compel an individual to provide or assist in providing medical assistance in dying. Therefore, a nurse may conscientiously object.
- Nurses who conscientiously object must transfer the care of the patient to another nurse or health care provider who will address the patient’s needs
- The nurse must continue to provide other nursing care, as per the patient’s care plan that is not related to activities associated with medical assistance in dying
12
Q
Metabolic Emergencies
A
- Tumour Lysis Syndrome
- Malignancy-induced hypercalcemia
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
13
Q
Hematological Emergencies
A
- Febrile neutropenia
- Disseminated Intravascular Coagulation (DIC)
14
Q
Structural Emergencies
A
- Superior Vena Cava Obstruction (SVCO)
- Metastatic Spinal Cord Compression (MSCC)
- Malignant pleural effusion
- Brain metastases
15
Q
Paraneoplastic Syndromes
A
- Rare disorders present with underlying malignancy
- Altered immune system - T cells attack normal cells
- Develop over few days to weeks
16
Q
Tumour Lysis Syndrome
A
- Caused by tumour cell breakdown
- Releases cellular contents into bloodstream
- Kidneys are not able to clear
- Commonly occurs with aggressive treatment
- Onset within 48h of treatment, lasts 5-7 days
17
Q
TLS Management
A
- Blood chemistry, urinalysis, cardiac assessment
- Meds to stop uric acid production
- IV fluids
18
Q
TLS Presentation
A
- Acute renal failure
- Cardiac arrhythmias
- Hyperkalemia
- Hypocalcemia
- Neuro
19
Q
TLS Nursing Considerations
A
- Monitor vitals
- Electrolytes
- Telemetry
- Low K & phosphate diet (renal diet)
20
Q
Malignancy-Induced Hypercalcemia
A
- Most common oncological emergency
- Poor prognosis (survival 3-4 months)
- Osteoclasts break down damaged/old bone
- Increase calcium levels in blood
- Untreated calcium levels of >4mmol/L - death in a few days
21
Q
Malignancy-Induced Hypercalcemia Presentation
A
- Irritability, lethargy, depression, confusion, psychoses
- ECG changes, bradycardia, atrial arrythmias
- Anorexia, N/V, constipation, ileus
- Fatigue, weakness, bone pain
- Thirst, polyuria, dehydration, renal failure
22
Q
Malignancy-Induced Hypercalcemia Management
A
- Blood test, ionized calcium
- Total calcium
- Treat malignancy
- Lower serum calcium levels - rehydration/diuretic
23
Q
Malignancy-Induced Hypercalcemia Nursing Considerations
A
- Monitor vitals - cardiac, neuro
- Encourage fluids - excrete calcium
- Meds for N/V/constipation
- Avoid vitamins & antacids
- Fluid balance
- Safety/mobility
24
Q
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
A
- Excessive free water retention & impaired water excretion
- Unregulated release of ADH by tumour
- High ADH = kidneys conserve water & concentrate urine
- Develop hyponatremia
- Intracellular & cerebral edema
- Decreased neural function & death
25
SIADH Presentation
- Early: N/V, fatigue, muscle cramps
- Late: changed mental status, hallucinations, weakness
26
SIADH Management
- Blood, urine, K levels
- Severity determine fluid restriction
- Continued lab monitoring - q2h if severe
27
SIADH Nursing Considerations
- Monitor vital & neuro assess - changes from baseline
- Fluid balance, daily weights, oral care
28
Febrile Neutropenia
- Impaired immune response to bacterial infections
- Serious complication of chemo
- Neutrophil count below normal
- Fever - oral temp >38
29
Feb Neut Presentation
- Fever
- Tachycardia
- Hypotension
- Diaphoresis
- Cough
- SOB
30
Feb Neut Management
- Medical emergency - septic shock if not treated
- Bloodwork, cultures
- IV antibiotics, infectious disease consult
- Remove infected lines
31
Feb Neut Nursing Considerations
- Monitor vitals, antibiotics, antipyretics
- Reverse isolation
- Patient/family education
32
Disseminated Intravascular Coagulation DIC
- Caused by cancer or treatment
- Overactivation of coagulation - hypercoagulable state
- Uses up clotting factors - widespread bleeding
- Block organs, damage, failure
33
DIC Presentation
- Bleeding from multiple sites
- Jaundice
- Necrosis/gangrene
- End-organ damage - renal, lungs, heart, brain
34
DIC Management
- Blood tests - CBC, clotting, platelets
- Underlying cause
- Infusions
- Heparin - prevent clotting
35
DIC Nursing Considerations
- Monitor vital & bleeding
- Administer blood/fluids
- Bleeding precautions, wound care
- Resp support
36
Malignant Spinal Cord Compression
- Compression of thecal sac by tumour
- Causes edema
- Infarction to spinal cord if not quickly relieved
- Irreversible neurologic damage
- Thoracic spine most commonly affected
37
Malignant Spinal Cord Compression Presentation
- Back pain - worse when lying
- Limb weakness
- Loss of motor function, difficulty walking
- Loss of anal sphincter tone
- Bowel incontinence - diarrhea
- Urinary retention/incontinence
38
Malignant Spinal Cord Compression Suspicion
- Known cancer diagnosis with bone metastases
- Night time pain during movement
- Band-like bilateral nerve root pain
- Unsteadiness of gait
- Progressive weakness of limbs
- Bowel & bladder symptoms
39
Malignant Spinal Cord Compression Management
- MRI with contrast
- IV steroids
- Urgent consult - neuro surgery, radiation oncology
40
Malignant Spinal Cord Compression Nursing Considerations
- Neuro assessments
- Pain management
- Glucose monitoring if on steroids
- Skin integrity/turns
- Fluid balance/bladder/bowel
41
Superior Vena Cava Obstruction (SVCO)
- Extrinsic compression or direct tumour invasion
- Impairs venous return to heart
- Common with lung cancer/non-Hodgkin lymphoma
42
SVCO Caused by
- Thrombus
- Tumour invasion
- External pressure
43
SVCO Presentation
- Dyspnea
- Facial edema
- Distension of neck/chest veins
- Cough, hoarseness, chest pain
- Altered mental status if cerebral edema
*Dyspnea, distension, dilated veins - main symptoms
44
SVCO Management
- Blood gases
- CT MRI
- Steroids
- Radiation, chemo
- Stenting if thrombus
45
SVCO Nursing Considerations
- ABCs
- Neuro status
- Elevate HOB
- Fluid monitoring
46
Malignant Pleural Effusion
- Cancer cells spread to pleural space
- Increase production of pleural fluid
- Decreased absorption of fluid
47
Malignant Pleural Effusion Presentation
- Chest pain
- Fever
- Fatigue
- SOB
- Cough
48
Malignant Pleural Effusion Management
- Imaging
- Biopsy
- Pleural drain, repeat thoracentesis, pleurodesis
49
Malignant Pleural Effusion Nursing Considerations
- Vitals
- Resp status
- Elevate HOB
- Pain management
- Fluid balance
50
Post-Thoracentesis Monitoring
- Bleeding
- SOB
- Pain
- Infection
51
Brain Metastases
- Secondary cancer
- Passes through bloodstream - breakdown in blood brain barrier
- Major cause of morbidity & mortality
52
Brain Metastases Presentation
- Headaches
- Seizures
- Altered mental status
- Increased ICP
- Blurry vision
- Nausea
53
Brain Metastases Management
- CT MRI
- Urgent treatment - improve neuro deficits & QOL
- Steroids for intracerebral edema
- Surgery, radiation, chemo
54
Brain Metastases Nursing Considerations
- Monitor neuro, vitals, seizure activity
- Symptom management - pain & nausea
- ADLs - safety
55
Death Definition
Cessation of vital organs/function
56
Dying Definition
Process individual approaches death
