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NURS 3510 - Supportive and Palliative Care > Week 8 > Flashcards

Week 8 Flashcards

1
Q

what is a palliative care emergency?

A
  • acute change in condition resulting in decreased QOL, comfort, and risk to life
  • includes pain and emotional sufferring
  • sudden and severe exacerbation in symptoms that negatively impact QOL and can lead to death
  • kind of like a code, but diff goal (make comfortable)
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2
Q

what are 3 examples of paliative care emergencies

A
  • spinal cord compression
  • exsanguination
  • dyspnea crisis
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3
Q

what are imp considerations for palliative care emergencies (3)

A
  • consider context
  • focus not on what can be done, but what is the appropriate treatment for the particular pt in the particular situation
  • each situation is unique
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4
Q

what factors must be taken into consideration in the mngmt of palliative care emergencies (4)

A
  • prognosis (days, months, years to live?)
  • wishes (what is imp to them, ACP)
  • impact of the condition on the whole person & QOL
  • considerations regarding the outcomes of the treatment (risk vs benefits)
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5
Q

what is the nurses role r/t palliative care emergencies (6)

A
  • anticipate pall care emergencies
  • identify risk factors
  • identify baseline and assess condition and deviations from baseline
  • collaborate w IPC team
  • manage symptoms and provide support (not only physical)
  • educate
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6
Q

how is spinal cord compression considered a palliative care emergency

A
  • can cause paralysis and permanent damage
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7
Q

what is spinal cord compression

A
  • occurs when a spinal cord tumour or metastatic tumour grows in the spine & detsroys the bony vertebral body that surrounds the cord, or wraps around thw spinal cord and its nerve roots
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8
Q

what are risk factors for SCC (6)

A
  • breast cancer
  • lung cancer
  • prostate cancer
  • renal cancer
  • multiple myeloma
  • lymphoma

cancers that tend to metastasize

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9
Q

why is SCC an emergency?

A
  • if it is not promptly assessed, recognized, and treated it can result in permanent paralysis = signif impact on QOL
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10
Q

what are signs of SCC (4)

A
  • back pain ***
  • motor weakness (heavy, weak legs)
  • sensory disturbances (numbness)
  • autonomic dysfunction
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11
Q

describe back pain r/t SCC (3)

A
  • occurs in majority of pts w SCC
  • local or radicular pain
  • may experience band like pressure radiating from back to front
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12
Q

what causes back pain d/t SCC to worsen (4)

A
  • straight leg raises
  • when lying down
  • at night
  • when intrathoracic pressure is increased (ex. coughing)
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13
Q

what are signs of autonomic dysfunction (2)

A
  • loss of bladder control (incont or retention)

- loss of bowel control (incont. or constipation)

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14
Q

what should be included in assessment of SCC (4)

A
  • pain assessment
  • neuro assessment (reflex, motor strength, sensation)
  • assess GU (incont or retention)
  • assess BM
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15
Q

what should be included in GU assessment for SCC (4)

A
  • last void
  • how much voided
  • bladder scan
  • palpate
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16
Q

what should be included in BM assessment for SCC (3)

A
  • LBM
  • change from normal?
  • incont?
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17
Q

what is the gold standard for diagnostic investigation of SCC

A
  • MRI
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18
Q

what is included in a neuro assessment r/t spinal cord compression (3)

A
  • sensations
  • motor
  • reflexes
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19
Q

what should be included in pain assessment of SCC (5)

A
  • OPQRSTU
  • social pain
  • spiritual pain
  • emotional pain
  • what makes physical pain worse (ex. straight leg raises, lying down)
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20
Q

what does the U in OPQRSTU stand for

A
  • what impact does it have on yiu

- what is your understanding

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21
Q

what are the goals of SCC management (4)

A

varies by person, may be:

  • improved pain
  • improved QOL
  • improved independence
  • improve survival
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22
Q

what is imp to consider for an appropriately guided treatment of SCC (2)

A
  • understand pt’s goals

- understand clinical scenario

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23
Q

what med is used for treatment of SCC

A
  • dexamethasone , usually high dose
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24
Q

what effect does dexamethasone have on SCC (4)

A
  • reduces inflammatyion
  • reduces swelling
  • relieves pain
  • helps preserve/improve function
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25
Q

what should you monitor for w a pt on dexamethasone (7)

A

steroid related s/e:

  • hyperglycemia
  • impaired wound healing
  • immunosuppression = risk of infection
  • sleep disturbances
  • mood changes
  • GI irritation
  • fluid retention
26
Q

what else is included in mngmt of SCC (7)

A
  • neurosurgery for spinal decompression and stabilization
  • radiation for pain
  • pain mngmt
  • bowel mngmt
  • bladder mngmt
  • DVT prophylaxis
  • rehab (OT, PT)
27
Q

why is bowel mngmt imp for SCC mngmt

A
  • opioids (for pain) + spinal cord dysfunction + inability to mobilize = risk of constipation
28
Q

what interventions can help w bowel mngmt for SCC (2)

A
  • bowel schedule

- assess for and treat constipation

29
Q

what interventions can help manage the bladder w SCC

A
  • retention = cath

- incont = keep clean & dry

30
Q

nursing care for SCC includes (4)

A
  • skin care (turns, keep clean & dry, imp d/t immbolity, incont.)
  • monitor function
  • monitoring pain
  • educate and support the pt
31
Q

what should you do first if a pt is experiencing signs of SCC

A
  • emergency MRI

- report to HCP

32
Q

what is a good question to use to guide your education of the pt and family on SCC

A
  • tell me what your understanding is of what’s happening
33
Q

what are malignant wounds (3)

A
  • a break in the epidermal integrity caused by infiltration of malignant cells
  • cancer infiltrating skin, afferent blood & lymph vessles
  • cancerous, open lesion in skin
  • may look like a cavity or be nodular
34
Q

what are malignant wounds also called (4)

A
  • fungating tumours
  • tumour necrosis
  • ulcerative malignant wounds
  • fungating malignant wounds
35
Q

what do malignant wounds result in (6)

A
  • ulceration
  • exudate that would appear anytime during day or night
  • leakage
  • unpleasant odour
  • pain
  • bleeding
36
Q

where do malignant wounds often occur (6)

A
  • breast
  • head
  • neck
  • genitalia
  • groin
  • back
    + other areas
37
Q

what is the life expectancy of a pt with a malignant wound

A
  • 6-12 months

malignant wounds do not heal

38
Q

what should be included in assessment of malignant wounds (4)

A
  • history
  • pain (all four domains)
  • pruritis (d/t stretching of skin)
  • wound assessment
39
Q

what should be included in assessment of history r/t malignant wounds

A
  • where
  • when did it occur
  • has anything been used to try to treat it? did it work or not?
40
Q

describe the impact of malignant wounds on all 4 domains (14)

A

may experience

  • changes w body image
  • embarressment
  • depression
  • fear
  • anxiety
  • shame
  • denial
  • guilt
  • difficulty utilizing resources
  • changes in social activities
  • loss of feminitity, attractiveness, sexuality
  • partners avoid touching or talking about wound
  • isolation
41
Q

what impact has the embarressment some pts feel regarding malignant wounds have

A
  • restricted social behavior

- embarressed to show to doctors = prolonged diagnosis

42
Q

what was most distressing r/t malignant wounds in the reading

A
  • odor mngmt –> compared to rotting mear or mold
43
Q

describe the exudate of malignant wounds

A
  • very copious

- required clothing changes constantly and dressing changes q4h

44
Q

what is included in mngmt of malignant wounds (4)

A

manage:

  • exudate
  • odour
  • bleeding
  • physical pain

focused on mngmt, not treatment

45
Q

who may be consulted to assist w management of malignant wounds

A
  • wound care specialist

- consult to palliative care team

46
Q

what is included in mngmt of physical pain r/t malignant wounds

A
  • pharmacological (opioids, non-opioids, adjuvants)

- non pharm

47
Q

what is included in mngmt of odour associated w malignant wounds (6)

A
  • wound cleansing
  • charcoal dressing (absorb exudate, trap odour)
  • topical flagyl
  • systemic anitbiotics that may be used to irrigate
  • room ventilation & circulation
  • kitty litter under bed
48
Q

why is odour significant w malignant wounds

A
  • d/t necrotic tissue & bacterial growth
49
Q

what is included in mngmt of bleeding r/t malignant wounds (5)

A
  • nonadherent dressings
  • hemostatic agents
  • minimize unnecessary dressing changes
  • gentle wound care
  • moist wound bed
50
Q

what is an example of a hemostatic agent for malifnant wounds

A
  • silver nitrate
51
Q

what is included in nursing mngmt of exudate r/t malignant wounds (2)

A
  • many types of dressings

- change PRN and based on amt

52
Q

what is included in mngmt for pruritis r/t malignant wounds (2)

A
  • promote hydration

- moisturization of periwound

53
Q

what should nurses do when caring for a pt with a malignant wound (7)

A
  • active listening
  • “normalize the experience”
  • get to know the person
  • consult wound care specialist
  • brainstorm ways to manage
  • validation
  • affirmation
54
Q

what should nurses NOT do when caring for a pt with a malignant wound (3)

A
  • say “its not that bad”
  • comment or make faces r/t odour
  • provide false reassurance
55
Q

what is exsanguination

A
  • acute catastrophic bleed where the pt is likely to die in a short amt of time
56
Q

what are common contributors to exsanguination (4)

A
  • liver failure (r/t varices, impact on plts and vit K)
  • thrombocytopenia
  • DIC
  • certain cancers
57
Q

what plt count is considered thrombocytopenia

A

plts <150

58
Q

what certain cancers are common contributors to exsanguination (3)

A
  • tumours arising from head & neck cancers (esp if close to blood vessels)
  • lung cancer
  • gynecological cancer
59
Q

describe what is included in plan of care for exsanguination (5)

A
  • identify those at risk
  • prep pts, families, and staff in advance
  • educate
  • develop a plan of care for those at risk
  • mngmt depends on ACP status and amt/type of bleed
60
Q

what interventions are included for exsanguination (8)

A

for rapid blood loss and ACP C:

  • stay with the person
  • have dark towels supplied in the room (mask amt of blood, reduce fear & anxiety)
  • assist pt in comfy position (ex. coughing up blood = sit up)
  • hold pt’s hand and therapeutic touch
  • apply pressure to site of bleeding
  • suction oropharyngeal airway w Yankauer suction
  • cover suction canister w towel
  • meds (if time)
61
Q

what meds may be given for exsanguination

A
  • benzo (ex. midazolam) –> sedative
  • opiods

if know pt at risk, have the meds ordered and ready to go on MAR (crisis meds)

NURS 3510 - Supportive and Palliative Care (11 decks)

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