Lecture #11 - Sx Management Flashcards Preview

NUR1 322 - Chronic Illness and Palliative Care (Xavier) > Lecture #11 - Sx Management > Flashcards

Flashcards in Lecture #11 - Sx Management Deck (28):
1

CARES acronym stands for (nurse driven)? Provides?

- Comfort
- Airways: management of dyspnea. Oral suctioning ineffective, b/c rapidly re accumulate and increase agitation. Morphine is recommended standard for treat. of shortness of breath. O2 supplementation is often ineffective in dying process, but reassures family.
- Restlessness and delirium
- Emotional and spiritual support
- Self-Care: for nurses mental health
- Sx-based care during the last days of life.

2

Double-effect?

Intervention with benefits outweighing the negative risks. Intent is to relieve suffering and not euthanize pts.

3

Common Sx in EOL?

pain, fatigue, cachexia, confusion, peripheral edema, skin ulcers, anxiety, depression, dyspnea, N/V, constipation/D

4

Sx are under-reported? stats?

1/3 Sx experienced were self-reported

5

What is total pain?

It is social, psychological, spiritual and physical pain.

6

WHO five essential concept to drug therapy of pain?

1) Oral route is preferred for nociceptive/neuropathic pain.
2) For persistent pain, around-the-clock meds + PRN should be used.
3) Move up the ladder: non-opioid -> weak opioid -> strong opioids (codein to morphine) and not side-ways (morphine to oxycodone)
4) Dose varies from individuals. The RIGHT DOSE relives pain with fewer SE.
5) Other factors need to be addressed (spiritual, psychological, etc) in addtition to pharma

7

Pain management four step process?

1)Assessment
2)Weigh benefit/burdens of each treatment
3)Manage pain with individualized specific interventions
4) Continuously reassess treatment goal

8

Pain assessment?

pain history, believing pt, numeric pain scale and what are the functional goals?

9

Physical sign pt is in pain?

grimacing, furrowed brows, restlessness, moaning, tears

10

unconscious pt experience pain?

YES

11

Why does breakthrough pain (spike) occurs?

End of dose
Incidental (happens with specific activities)
Idiopathic (true breakthrough pain

12

Breakthrough doses?

same molecules
10% of daily opioid regularly given q1h PRN

13

Adjuvant drugs?

Non-opioid that enhance analgesia

14

Adjuvant drugs for bone pain?

NSAIDS, steroids, bisphosphonates

15

Adjuvant drugs for neuropathic pain?

TCA, gabapentin, cortico

16

Opioid neurotoxicity?

Renal failure
Sx: hyperalgia, myoclonus, delirium, convulsions

17

If pt doesn't achieive pain control with opioid by how much can you increase the doses?

25-50%

18

When anorexia, does IV nutrition/hydration prolong life/well being in EOL?

NOt proven, but if not close to death, hydration will help.

19

When not to hydrate?

Terminal hase
severe edema
prone to pulm. edema

20

Change in resp patterns = dyspnea?

NO

21

Can Rx alter resp. patterns?

NO

22

Interventions in managing dyspnea?

- Reassurance
- 45-90degrees
- open windows
- fan
- relaxation
- avoid irritants

23

Does morphine hasten death?

NO, when doses proportionate t degree of distress

24

Supplemental O2 recommended to?

Hypoxic pt experiencing dyspnea. But if not hypoxic, it is not recommended.

25

Dyspnea management generally focuses on?

Comfort and not oximetry

26

When to consider suctioning?

If secretion proximal and pt not responding to anti secretory agents.

27

What is PPS scale?

Palliative Performance Scale

28

Management of fatigue?

Treat cause if possible. (Eg. anemia = blood)