Week 4 - Palliative - Part 2 Flashcards
What are the 5 domains of quality EOL care?
- Receiving adequate pain and symptom management
- Avoiding inappropriate prolonging of dying
- Achieving a sense of control
- Relieving burden (to others)
- Strengthening of relationships with loved ones
What are the 5 most prevalent symptoms in palliative care?
Dyspnea, constipation, fatigue, pain, delirium
unpleasant sensory awareness of breathing; subjective experience of difficulty or uncomfortable breathing
Dyspnea
What pharmacologic agents are used in the management of dyspnea?
Aerosol corticosteroids and bronchodilators
in the palliative patient, opioids (e.g. morphine/hydromorphone) can help steady breathing and take away air hunger
Anxiolytics - Haldol or BDZs
disease specific:
COPD - nebulizer
CHF lung congestion - Lasix, glycopyrolate (not too early)
Why don’t we want to give glycopyrolate too early in CHF patients?
Might dry up secretions and create a mucus plug
What is another word for haldol?
vitamin H
Why is Haldol given for dyspnea in the palliative patient?
Anxiety is usually the largest factor that causes dyspnea
What are some non-drug interventions for dyspnea?
DB&C, meditation, music therapy, raising HOB, chest physio
push ribcage as patient is breathing to push out mucus
humidified nasal prongs
How does one screen for constipation?
Auscultate for bowel sounds
check for abdominal distension
ask about last BM
Describe the prevention of constipation.
Get them up and moving
Preventing it by using laxatives (oral first, then PR)
fibre and fluids (metamucil, prune juice)
What are pharmacologic agents to treat constipation?
Laxatives, lactulose, senna, peglyte, etc.
When will a suppository not work?
When the stool is not right there when you put it in
What are some non-drug ways to manage constipation?
Ambulation, prune juice, digitally removing stool (if a doctor’s order is present and their condition warrants it)
What are ways to screen for fatigue?
Asking about their energy levels and sleep schedules
What are ways to manage fatigue pharmacologically?
Haldol for deeper sleep
lowering haldol dose when they want to be awakre
(caffeine - but careful about constipation)
What are non-pharmacological ways to manage fatigue?
Encouraging sleep
Talk to them, get them up to a window, etc.
What is one of the most feared and incapacitating symptoms among patients facing the end of life?
pain
Pain is what….
the patient says it is
What is the OPQRST acronym?
Onset, palliation/provocation, quality, radiation, severity, time
For palliative patients, is it detrimental to give pain meds when you see them furrowing their brow or when they say they are in pain?
No - never think that if you give the next dose of hydrophone you will kill them
(focus on QOL and pain management - if q2 but only 1hr and a half passed - call physician for pain meds)
What are some non-pharmacological pain aids?
o Heat or cold packs o Extra pillows o Warn blanket o Guided meditation o Dogs/pets o Closing blinds, turning lights off – for migraines o Keeping noise at a minimum o Keeping them on their favourite side
A cognitive disturbance resulting from an altered mental state, described in terms of disrupted consciousness and impaired cognition (thinking, perception, memory)
Delirium
What is another word for delirium?
Terminal restlessness
What are common causes of delirium?
o UTI/infections o New location o Med interactions o Pain o Electrolyte imbalances o Head injury o Tumour o Bleeds
How does one assess for delirium?
History
Delirium chart
asking a family member
What are some considerations for ABx use in palliative patients who may be delirious?
If they are close to death, better to just give antibiotics rather than try to determine agent - especially if blood cultures are needed
What is a drug often given for delirious patients?
Haldol
What are non-pharmacological ways to manage delirium?
Reorient if possible
music
talking through it
What is the number one takeaway for delirious patients?
Safety first - make sure the patient is safe - use family members, restraints or bed alarms as necessary
What are some societal factors that are leading nurses of all floors to need to understand palliative care?
Both kids are working and cannot care for parent
People are living longer and have more complex conditions
Aging population
Trajectories of death - e.g. CHF
What are some complementary therapies?
Herbal therapies, manual therapies like reflexology and acupuncture
Describe FNs healing Canadian Cancer society
Holistic approach to health
integrates traditional healing practices - e.g. special ceremonies, rituals and herbals
FNs healers believe that the body, mind and spirits must work in harmony and balance to be healthy
Can smudging ceremonies occur in the hospital?
No, would need to find another area since the scent-free policy wins
Describe a good death.
- Free from avoidable distress and suffering for patient, family and caregivers
- Patient’s and family wishes met
- Consistent with clinical, cultural and ethical standards
What are some reasons that it is hard to talk about EOL decisions?
- People don’t like to talk about death
- Fear of giving up
- Don’t know options available to them
- Uncertainty about client wishes
- Cultural, spiritual and religious traditions
- Previous experiences with death
- Emotional component
What are the requirements for MAID?
- Competent adult person
- Clearly consents to the termination of life
- Not the result of outside pressure
- The patient must be suffering from a terminal illness in an advanced state of decline and cannot be reversed
- Pt must be suffering unbearably
