End of life Flashcards
(37 cards)
1
Q
dying
A
- decline in body function -> death
2
Q
death
A
- final cessation of vital functions
3
Q
brain death
A
- irreversible cessation of brain stem
4
Q
signs pt is actively dying
A
- death rattle
- jaw movement increases with breathing
- cyanosis and skin mottling
- no radial pulse
5
Q
what is the death rattle
A
- retention of fluids in pharynx and upper respiratory tract
- causes audible breathing
- keep bed at 45 degree angle to help
6
Q
cheyne-stokes respirations
A
- changes in breathing that occur right before death
- irregular breathing patterns
7
Q
pain management treatment options
A
- treat based on severity and type of pain
- non-opioids: tylenol or NSAIDs
- opioids
- adjunct therapy- anti-convulsants, steroids, TCAs
8
Q
what are examples of weak opioids
A
- codeine
- hydrocodone
- oxycodone (oxycontin)
- aka weak affinity for receptors
9
Q
what are examples of strong opioids
A
- morphine
- hydromorphone (dilaudid)
- fentanyl
10
Q
how is fenatnyl absorbed as a patch
A
- lipophilic so needs fat
- often dying pts have decreased fat so it is less likely to be absorbed and effective
11
Q
how long is the half life of most opioids?
A
- 3-4 hours with normal renal function
12
Q
morphine considerations
A
- dialyzes off
- will accumulate in renal failure -> neuroexcitation and CNS effects
13
Q
hydromorphone considerations
A
- inactive metabolites
- DOC in renal failure
14
Q
methadone considerations
A
- may cause QTc prolongation
- requires frequent EKG monitoring
15
Q
possible causes of dyspnea
A
- increased dead space or airway resistance
- decreased lung compliance or hemodynamic abnormalities
- airway obstructions
- muscle weakness
- cardiac issues, anemia
- intraabdominal processes
- psychological- anxiety
16
Q
what should you educate pts and families about in terms of dyspnea?
A
- changes in respiratory patterns may not equal dyspnea
- drugs may remove perception of dyspnea but not alter breathing patterns
- explain possible reasons for dyspnea
17
Q
treatment for dyspnea
A
- oxygen- even if not hypoxic
- opioids- esp morphine due to venodilation and sedation
- BZDs/ anxiolytics
- steroids
- thoracentesis or paracentesis
- palliative radiation
- inhaled bronchodilators if bronchospasm
18
Q
non-pharm approaches for dyspnea
A
- avoid exacerbating activities
- reduce temp and maintain humidity
- window/ bring pt outside
- avoid irritants
- elevate head of bed
- relaxation therapies
19
Q
opioids and dyspnea
A
- most effective if stead state blood levels
- causes suppression of respiratory drive with peaks and valleys
- if pt is on opioid for pain then dev dyspnea increase dose by 25-50%
20
Q
nausea
A
- stimulation of GI lining, chemoreceptor trigger zone in 4th ventricle, vestibular apparatus, or cerebral cortex
- cerebral cortex= learned response
21
Q
vomiting
A
- neuromuscular reflex centered in medulla oblongata
22
Q
mediators of N/V
A
- serotonin
- dopamine
- acetylcholine
- histamine
23
Q
pharmacologic treatment for N/V
A
- dopamine antagonists
- histamine antagonists
- serotonin antagonists
- prokinetic agents
- antacids- tums
- steroids
- cannabinoids
- BZDs- for anticipatory nauesa
24
Q
examples of dopamine antagonists
A
- pramipexole dihydrochloride
- ropinole
25
examples of histamine antagonists
- diphenhydramine
| - meclizine
26
examples of serotonin antagonists
- zofran
27
examples of prokinetic agents
- metoclopramide
| - good for paralytic ileus
28
causes of constipation
- drugs* esp opioids
- metabolic
- diet
- decreased motility
- SC compression
- mechanical obstruction
- dehydration
- autonomic dysfunction
- ileus
- treating cause in advanced stages might not always be appropriate
29
nonpharm treatment options for constipation
- scheduled toileting
- position to sit upright
- fluids
- avoid bulking agents- might precipitate obstruction
30
pharm treatment options for constipation
- stimulant or osmotic laxatives
- detergent laxatives (stool softener)
- enemas
- opioid antagonists- methylnaltrexone
31
terminal delirium
- common near end of life esp in geriatrics or hospitalized pts
- can be reversible
- spiritual and emotional needs of pt must be addressed
32
si/sx of terminal delirium
- agitation/ irritability
- impaired consciousness
- myoclonic jerks or twitching
- hallucinations, paranoia
- confusion and disorientation
33
causes of terminal delirium
- opioid toxicity
- pain-> agitation
- drug interactions- esp hypnotics, antimuscarinics, and anticonvulsants
- fever or sepsis
- hypercalcemia-> confusion and agitation in cancer pts
- increased ICP -> agitation
- may be imbalance between acetylcholine and dopamine
34
nonpharm treatment options of terminal delirium
- create familiar environment
- reassure pt/ family
- give permission to let go
- use touch/ soothing touch
- maintain sleep- wake cycles
35
pharm treatment options for terminal delirium
- BZD- may make things worse
- neuroleptics- haldol, chlorpromazine
- treat seizures
36
anorexia
- inflammatory process -> loss of fat and muscle
- common in advanced illness
- often see with asthenia
- increased nutrition doesnt reverse/ improve cachexia or stop disease process
37
anorexia treatement
- search for and treat specific causes i.e. nausea, emesis, pain
- if no specific etiology ID then consider pt QOL and try to balance normalcy in daily living
- educate that it is normal to not feel hunger/ thirst
- pharm options- steroids, progesterone drugs, mirtazapine, and androgen
