End of life care, Unrein 4Q

Question 1

palliative care

Answer 1

specialized medical care for people with serious illness

Question 2

examples of terminal illness

Answer 2

cancer
HIV
cardiac disease
pulmonary disease
renal disease
liver disease
NM disease
stroke/coma
dementia

Question 3

hospice interdisciplinary team

Answer 3

physician
nurse case manager
dietary counselor
medical social worker
bereavement counselor

Question 4

4 components medical ethics

Answer 4

autonomy
beneficence
nomaleficence
justice

Question 5

what is the double effect or primum non nocere

Answer 5

permissibility of action thta cause serious harm like death

physician assisted suicide

Question 6

euthanasia

Answer 6

act ending patients life when carried out by physician personally

Question 7

most reliable method evalutaiton pain

Answer 7

patient self reporting pain

Question 8

total pain

Answer 8

recognition that pain is beyond physical
spiritual/existential
emotional/psychological

Question 9

types of physical pain

Answer 9

somatic: aching, stabbing, throbbing
visceral: spastic, cramping, squeezing
neuropathic: burning, shooting, tingling, numbness

Question 10

MOA opioids

Answer 10

modulate pain
inhibit Ca to inhibit release of NT
modulate sensation SOB in resp center of brain

Question 11

use of opiods for mild to mod pain

Answer 11

codeine

hydrocodone

Question 12

opiods for mod to severe pain

Answer 12

morphine
hydromorphone
oxycodone
fentanyl
methadone

Question 13

route of administration of opioid that is undesireable

Answer 13

IM

Question 14

meperidine

Answer 14

opioid

Question 15

side effects opioids

Answer 15

constipation!
nausea
somnolence
myoclonus and neurotoxicity

Question 16

side effects opioids

Answer 16

constipation!
nausea
somnolence
myoclonus and neurotoxicity

Question 17

why don’t mroe physicians prescribe opioids

Answer 17

fear of DEA retribution and lack of experience with high doses

Question 18

which opioid are many medical professionals afraid to use

Answer 18

heroin

Question 19

non opioid pain meds

Answer 19

acetaminophen
NSAIDs
corticosteroids
anticholinergics
antidepressants
anticonvulsants
antiarrhythmics

Question 20

palliatve sedation

Answer 20

terminal sedation
once all other measures exhausted
allow patient to die peaecfully

Question 21

kif constipation caused by medications

Answer 21

do not use laxatives
use methynaltrexone or stimulant laxatives, enemas
prevention!

Question 22

underlying causes of dyspnea

Answer 22

CHF COPD pleural effusions, pneumonia, anemia, mm weakness, emotional distress, acidosis, hypoxia

Question 23

dyspnea Tx

Answer 23

responds well to systemic opioids

dec chemoR responsiveness to hypercapnia and inc peripheral vasodilation

Question 24

general measures for dyspnea

Answer 24

secretion manaagement, O2, fan, non-invasive ventilatory support

Question 25

causes of nausea

Answer 25

emotional malignancies pain

Question 26

Tx nausea from pain or emotion

Answer 26

dexamethasone counseling anti-anxiety, antidepressant and opioid meds

Question 27

Tx nausea from vestibular apparatus

Answer 27

antibiotics, anticholinergics, antihistamine

Question 28

causes of nausea in chemo trigger zone

Answer 28

drugs, uremia, electrolyte imbalance

Question 29

Tx of nausea in chemo trigger zone

Answer 29

find underlying cause and fix that | med- serotonin R antagonist

Question 30

causes of nausea from GI

Answer 30

obstruction, gag reflex, irritation and distention

Question 31

meds fo rGI nausea

Answer 31

anti inflammatory anticholinergics octreotide

Question 32

causes of delirium

Answer 32

``` medication metabolic abnormalities ifnecitons emotional distress uncontrolled pain terminal delirium ```

Question 33

Tx delirium

Answer 33

underlying cause antipsychotic meds like haloperidol or chlopromazine palliative sedation like midazolam propofol

Question 34

alternative palliative Tx

Answer 34

``` aromatherapy massage and manipulation music relaxation cannabinoids ```