Flashcards in Communication with pts with serious illnesses Deck (60):
What are the three causes of non-pain symptoms?
What are the characteristics of palliative care medicine?
True or false: palliative care pts do not volunteer all of their symptoms
True or false: Symptom distress is not always in proportion to severity
What is the way to identify hidden symptoms in palliative care pts?
Screen for them
What is the way to identify clinical symptoms?
When is the PE done relative to the other steps of the clinical symptom assessment
Treatments should be chosen based on what?
Goals of care
What can affect goals of care?
-rate or change of disease
What should you always look for in non-pain symptoms, if possible?
The cause of the symptom
How should you approach treatment of a multitude of symptoms?
Starting with the one that causes the most distress
Why is it important to get caregivers involved in screening for symptoms?
Pts may diminish symptoms
Why is it important to document assessment and plan?
SO you can review what happens
What are the three questions to ask in goal setting?
Are goals achievable
Are they beneficial
What are the eight common non-pain symtoms to focus on?
What happens to dyspnea as death approaches?
True or false: dyspnea occurs commonly in a broad range of diseases
True or false: anxiety breeds anxiety
What is the gold standard for detecting dyspnea?
True or false: dyspnea is an objective finding
True or false: stats do no reflect dyspnea
What is the first step in treating dyspnea
Identifying the cause
Treatment of dyspnea depends on what (besides the cause)?
Prognosis and goals of care
What are the causes of dyspnea (BREATH AIR)
How do we treat dyspnea pharmacologically?
How do we treat dyspnea non-pharmacologically?
Why should you not give high oxygen to CO2 retaining pts?
May lower their RR
What should you always write for when prescribing opioids?
Something to loosen stools
What are the general measures for treating dyspnea (that are not obvious)?
Skin care for buttocks
What is the position for treating dyspnea if they have a compromised lung?
Lie them down on the compromised lung
What is the MOA of cool air on the face reducing dyspnea?
Stimulation of CN V2
Why is pursed-lip breathing helpful?
Prolongs the expiration phase
What is the first step in treating dysphagia?
Determining if obstruction vs neurological
What is the treatment for dysphagia?
Good oral hygiene
True or false: taste disorders can cause dysphagia?
What type of foods should you avoid with dysphagia?
Sticky, hard or dry foods
What disease predisposes pts to anorexia?
What is the first step in identifying anorexia?
Hx and PE
What are the reversible causes of anorexia? (ANOREXIA)?
Aches and pain
Why do you need to be careful with prescribing appetite stimulants?
many, many side-effects
What is the main thing to identify with artificial nutrition and hydration?
Goal of care
True or false: ANH improves healing process of decubitus ulcers?
True or false: ANH lengthens survival
False--opposite it usually true
What are the complications of ANH? (3)
What is the perioperative mortality rate for PEG placement?
True or false: N/V is very common in terminally ill pts, and is very distressing
What percent of pts can n/v be controlled?
90% of pts
What are the four parts of the body that cause vomiting?
Where do all of the signals from the body go to trigger emesis?
How do you select antiemetics?
By identifying likely cause
What percent of malignant GI CAs have BO?
What are the PE findings of a BO?
High pitched BS
What does the treatment for malignant BOs depend on?
Goals of care
What are the treatments of Malignant BOs? (3)
What are the three types of altered levels of consciousness with delirium?
What is the most important thing to do when treating delirium?
Inform family, b/c they think you are not doing anything
What is the usual pharm treatment for delirium?
low dose non-sedating antipsychotics
What is the med to avoid with delirium?
What percent of critically ill pts develop delirium?