Lecture 11 - Palliative Flashcards
(52 cards)
What is the WHO definition of palliative care?
Care offered early in the course of the illness, in conjunction with other therapies that are intended to prolong life, and includes investigations to better understand and manage distressing clinical complications
What are 3 important concepts of palliative care?
Relief from pain, dying as part of the normal process of living, and to neither hasten nor prolong death
What does the model to guide palliative care suggest?
The initial focus of care is on therapy to modify disease, eventually replaced by palliative care. Then comes end-of-life care, followed by death. Death is followed by bereavement
What are common signs of imminent death?
Progressive weakness, bed bound, sleeping, decreased intake, darkened and decreased urine output, dysphagia, delirium, decreased LOC, noisy respiration, change in breathing pattern, mottling, cooling of extremities, dehydration
Which diseases are accompanied by chronic pain?
RA, liver failure, kidney failure, HIV, cancer, HF
Describe somatic pain
A localized achy, dull, throbbing or sore pain that arises from MSK
Describe visceral pain
A diffuse, difficult to localize, often referred gnawing, squeezing, cramping pain that arises from visceral organs
Describe neuropathic pain
A shooting, burning, tingling, stabbing pain that often follows a nerve path but can be diffuse due to injury to CNS or PNS
Pain assessment includes what acronym?
OPQRSTUV
What is the O component of pain assessment?
Onset - when did the pain (or new pain) begin? How long does it last? How often does the pain occur?
What is the P component of pain assessment?
Provoking/palliating - What brings the pain on? What makes the pain better? What makes the pain worse?
What is the Q component of pain assessment?
Quality - What does the pain feel like? Describe the pain.
What is the R component of pain assessment?
Region/radiation - Where is the pain? Can you point to the pain? Does the pain spread anywhere?
What is the S component of pain assessment?
Severity - What is the intensity of the pain? (Use age appropriate visual analog scale) On a scale of 0-10? Are there any other symptoms that accompany the pain?
What is the T component of pain assessment?
Treatment - What medications/ treatments are you currently using? How effective are these? What have you used in the past?
What is the U component of pain assessment?
Understanding impact - How is the pain affecting you/ your family? Sleep? Activity? What do you believe is causing the pain?
What is the V component of pain assessment?
Values - What is your comfort goal/ acceptable level of pain? (Use 0-10 scale or visual analog)
What are other factors that impact chronic pain?
Decreased/increased sensitivity, analgesic medication history, beliefs about pain and treatment, mental health, drug abuse, heart disease, diabetes
What is Stage 1 of WHO’s analgesic ladder?
Non-opioids
What are 2 examples of Stage 1 medications?
Acetaminophen and Cox-2 inhibitors
What is acetaminophen?
Non-opioid used for analgesic and antipyretic effects, not anti-inflammatory or anticoagulant.
What are potential complications of acetaminophen?
Hepatic and renal toxicities as well as overdose
What are Cox-2 inhibitors?
Non-opioid used for anti-inflammatory effects that can be used for patients with thrombocytopenia and has lower GI effects
What is a potential complication of Cox-2 inhibitors?
Risk of stroke and MI
