End of Life Care

Question 1

describe the trajectories seen

Answer 1

Question 2

describe hospice and palliative medicine

Answer 2

• affirms life, regards dying as normal
• team approach to enhance quality of life and positively influence course of illness
• offers support system to help patients live as acutely as possible until death
• relief from pain and distressing symptoms

Question 3

name the 5 key symptoms to control to optimize quality of life

Answer 3

• 5 key symptoms
  
  • pain
  • nausea and vomiting
  • agitation
  • dyspnea
  • retained repiratory secretions (RTS)
• assess and respond to psychological, social and spiritual needs

Question 4

describe the goals for care of the dying adult

Answer 4

• clinically assisted feeding and hydration
  
  • give by mouth for as long as possible
  • may relieve distressing signs of dehydration
  • unlikely to prolong life or the dying process
• review current medication
  
  • anticipate need to change meds and routes of administration
    
    • have readily available, note in prescription chart
• a bad death that was avoidable is a failure

Question 5

describe the analgesic ladder

Answer 5

• mild pain
  
  • aspirin, acetominophen, NSAIDS
• moderate pain
  
  • aspirin, acetominophen + opioids (codeine, oxycodone, tramadol)
• severe pain
  
  • morphine, methadone, fentanyl, + nonopioid analgesics

Question 6

describe the CDC guideline for prescribing opioids for chronic pain

Answer 6

• before starting and periodically during opioid therapy, discuss with patients known risks, realistic benefits and responsibilties
  
  • effectiveness and risks of long-term opioid therapy varies
  • nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred
  • before staring opioid therapy for chronic pain, establish realstic treatment for pain and function; consider how to discontinue if benefits do not outweight risks

Question 7

describe critical thinking skills

Answer 7

Question 8

what questions should be asked to elicit & document patient goals?

Answer 8

• what do you understand about your illness?
• how much do you want to know about what is likely to happen with your illness?
• who would you want to make decisions for you if you could not communicate?
• what are your most important goals now?
• what are your biggest fears and worries now?

Question 9

describe how physician should talk with patients during end of life care

Answer 9

• are there situations you would find unacceptable?
• how does your family feel about your preferences?
• encourage their questions and be prepared to answer them
  
  • look up outcome data specific to the patient
  • basis for prognosis and likely outcomes
• summarize your discussion
  
  • “so let me see if I understand what you are saying…”
• make recommendation based on patient goals and medical realities

Question 10

globally, opiods are ___ and pain is _____

Answer 10

globally, opiods are underused and pain is undertreated

Question 11

explain why opioid use in clinics is low among healthcare practitioners

Answer 11