Communication with pts with serious illnesses Flashcards Preview

Geriatrics > Communication with pts with serious illnesses > Flashcards

Flashcards in Communication with pts with serious illnesses Deck (60):
1

What are the three causes of non-pain symptoms?

Disease processes
Treatments
Comorbidities

2

What are the characteristics of palliative care medicine?

Polysymptomatic

3

True or false: palliative care pts do not volunteer all of their symptoms

True

4

True or false: Symptom distress is not always in proportion to severity

True

5

What is the way to identify hidden symptoms in palliative care pts?

Screen for them

6

What is the way to identify clinical symptoms?

H&P

7

When is the PE done relative to the other steps of the clinical symptom assessment

Almost last

8

Treatments should be chosen based on what?

Goals of care

9

What can affect goals of care?

-age
-functional status
-overall needs
-rate or change of disease
-life expectancy

10

What should you always look for in non-pain symptoms, if possible?

The cause of the symptom

11

How should you approach treatment of a multitude of symptoms?

Starting with the one that causes the most distress

12

Why is it important to get caregivers involved in screening for symptoms?

Pts may diminish symptoms

13

Why is it important to document assessment and plan?

SO you can review what happens

for others

14

What are the three questions to ask in goal setting?

Are goals achievable
Are they beneficial
How measure

15

What are the eight common non-pain symtoms to focus on?

Constipation
N/V
Diarrhea
BO
Anorexia
Delerium
Depression
Dyspnea

16

What happens to dyspnea as death approaches?

Worsens

17

True or false: dyspnea occurs commonly in a broad range of diseases

True

18

True or false: anxiety breeds anxiety

True

19

What is the gold standard for detecting dyspnea?

Self reporting

20

True or false: dyspnea is an objective finding

False-subjective

21

True or false: stats do no reflect dyspnea

True

22

What is the first step in treating dyspnea

Identifying the cause

23

Treatment of dyspnea depends on what (besides the cause)?

Prognosis and goals of care

24

What are the causes of dyspnea (BREATH AIR)

Bronchospasm
Rales
Effusion
Airway obstruction
Thick secretions
Hemoglobin low
Anxiety
Interpersonal issues
Religious concerns

25

How do we treat dyspnea pharmacologically?

Opioids
Anxiolytics

26

How do we treat dyspnea non-pharmacologically?

Oxygen
CPAP

27

Why should you not give high oxygen to CO2 retaining pts?

May lower their RR

28

What should you always write for when prescribing opioids?

Something to loosen stools

29

What are the general measures for treating dyspnea (that are not obvious)?

Skin care for buttocks

30

What is the position for treating dyspnea if they have a compromised lung?

Lie them down on the compromised lung

31

What is the MOA of cool air on the face reducing dyspnea?

Stimulation of CN V2

32

Why is pursed-lip breathing helpful?

Prolongs the expiration phase

33

What is the first step in treating dysphagia?

Determining if obstruction vs neurological

34

What is the treatment for dysphagia?

Good oral hygiene
Fix dentures
Calm down

35

True or false: taste disorders can cause dysphagia?

True

36

What type of foods should you avoid with dysphagia?

Sticky, hard or dry foods

37

What disease predisposes pts to anorexia?

CA

38

What is the first step in identifying anorexia?

Hx and PE

39

What are the reversible causes of anorexia? (ANOREXIA)?

Aches and pain
Nausea
Oral candida
Reactive depression
Evacuation problems
Xerostomia
Iatrogenic
Acid-related

40

Why do you need to be careful with prescribing appetite stimulants?

many, many side-effects

41

What is the main thing to identify with artificial nutrition and hydration?

Goal of care

42

True or false: ANH improves healing process of decubitus ulcers?

False

43

True or false: ANH lengthens survival

False--opposite it usually true

44

What are the complications of ANH? (3)

Infections
Thrombosis
Aspiration

45

What is the perioperative mortality rate for PEG placement?

6-24%

46

True or false: N/V is very common in terminally ill pts, and is very distressing

True

47

What percent of pts can n/v be controlled?

90% of pts

48

What are the four parts of the body that cause vomiting?

Cerebral cortex
Vestibular apparatus
Chemoreceptors
GI tract

49

Where do all of the signals from the body go to trigger emesis?

Vomiting centers

50

How do you select antiemetics?

By identifying likely cause

51

What percent of malignant GI CAs have BO?

50%

52

What are the PE findings of a BO?

High pitched BS

53

What does the treatment for malignant BOs depend on?

Goals of care
expected outcome

54

What are the treatments of Malignant BOs? (3)

Surgery
Endoscope
Meds

55

What are the three types of altered levels of consciousness with delirium?

Hyperactive
Hypoactive
Mixed

56

What is the most important thing to do when treating delirium?

Inform family, b/c they think you are not doing anything

57

What is the usual pharm treatment for delirium?

low dose non-sedating antipsychotics

58

What is the med to avoid with delirium?

Benzos

59

What percent of critically ill pts develop delirium?

50%

60

How do you prevent delirium?

Prevent dehydration
Remove caths
Decrease stimuli