Flashcards in Lecture #11 - Sx Management Deck (28):
CARES acronym stands for (nurse driven)? Provides?
- 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.
Intervention with benefits outweighing the negative risks. Intent is to relieve suffering and not euthanize pts.
Common Sx in EOL?
pain, fatigue, cachexia, confusion, peripheral edema, skin ulcers, anxiety, depression, dyspnea, N/V, constipation/D
Sx are under-reported? stats?
1/3 Sx experienced were self-reported
What is total pain?
It is social, psychological, spiritual and physical pain.
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
Pain management four step process?
2)Weigh benefit/burdens of each treatment
3)Manage pain with individualized specific interventions
4) Continuously reassess treatment goal
pain history, believing pt, numeric pain scale and what are the functional goals?
Physical sign pt is in pain?
grimacing, furrowed brows, restlessness, moaning, tears
unconscious pt experience pain?
Why does breakthrough pain (spike) occurs?
End of dose
Incidental (happens with specific activities)
Idiopathic (true breakthrough pain
10% of daily opioid regularly given q1h PRN
Non-opioid that enhance analgesia
Adjuvant drugs for bone pain?
NSAIDS, steroids, bisphosphonates
Adjuvant drugs for neuropathic pain?
TCA, gabapentin, cortico
Sx: hyperalgia, myoclonus, delirium, convulsions
If pt doesn't achieive pain control with opioid by how much can you increase the doses?
When anorexia, does IV nutrition/hydration prolong life/well being in EOL?
NOt proven, but if not close to death, hydration will help.
When not to hydrate?
prone to pulm. edema
Change in resp patterns = dyspnea?
Can Rx alter resp. patterns?
Interventions in managing dyspnea?
- open windows
- avoid irritants
Does morphine hasten death?
NO, when doses proportionate t degree of distress
Supplemental O2 recommended to?
Hypoxic pt experiencing dyspnea. But if not hypoxic, it is not recommended.
Dyspnea management generally focuses on?
Comfort and not oximetry
When to consider suctioning?
If secretion proximal and pt not responding to anti secretory agents.
What is PPS scale?
Palliative Performance Scale