Flashcards in Lecture 13 Cancer, pain, and end of life Deck (44):
Continuum of care across the lifespan
1. As a person ages, there is a *balance* between curative care and palliative care.
2. Palliative care and eventually *hospice care* assume a greater focus toward the end of life.
3. Hospice care culminates with death, and is followed by *bereavement care*.
Older adults and cancer
Older adults are disproportionately affected by cancer, less likely to be screened for cancer, and are diagnosed at a later stage.
Wellness outcomes related to cancer can be promoted by teaching about _
1. Primary prevention interventions.
2. Screening recommendations.
Regarding different ethnic groups, diabetes is especially prevalent among _
1. Native Americans and Alaskan Natives.
A leading cause of hospitalizations among older adults is _, and _ of admissions are potentially preventable with adequate self-care.
Heart failure; 57%.
Nurses promote caregiver well-being by identifying and addressing issues related to _
_ pain is time-limited and responsive to analgesics.
_ pain continues for a prolonged period and may or may not be associated with a recognizable disease process.
Process of pain conduction (nociception) in the body
1. *Transduction* of a noxious stimulus (tissue damage).
2. *Transmission* of action potentials from the site of damage to the brain.
3. *Perception* occurs when a person becomes conscious of pain.
4. *Modulation* is the body's response to the painful stimuli.
Type of nociceptive pain localized from muscle, joints, skin, etc.
Type of nociceptive pain that arises from internal organs and is often *referred*.
Pain caused by damage or disease affecting the central nervous system and/or peripheral nervous system (e.g., shingles).
A form of neuropathic pain caused by nerve damage due to the *varicella zoster virus*.
The most common cause of persistent pain in the older adult population is _
Arthritis (affects 49-59% of older adults).
One of the most common barriers to pain management with the older adult population is _
An erroneous attitude that pain is a normal part of aging.
Functional consequences of pain in the older adult include _
1. Diminished physical function.
2. Loss of mobility.
3. Higher levels of disability.
4. Decreased quality of life.
Pain that goes untreated can lead to serious consequences, including _
1. Medications that relieve pain by binding to opioid receptors in the *central nervous system*.
2. Examples: Codeine, oxycodone, morphine, tramadol, fentanyl, methadone.
1. Medications that act at the *site of the injury* to decrease pain.
2. Examples: Acetaminophen, NSAIDs, aspirin.
1. Medications that have a primary indication other than the treatment of pain, but may help relieve pain due to their effects on the *modulation phase*.
2. Examples: Antidepressants and anticonvulsants.
World Health Organization pain relief ladder
Step 1= Mild pain (1-3); treat with a non-opioid ± an adjuvant.
Step 2= Moderate pain (4-6); treat with an opioid for mild to moderate pain ± a non-opioid ± an adjuvant.
Step 3= Severe pain (7-10); treat with an opioid for moderate to severe pain ± a non-opioid ± an adjuvant.
Older adults experiencing *severe* pain are likely to be prescribed _
Stronger opioids with a *short half-life*.
Around-the-clock analgesia and breakthrough medications may be implemented for _
Moderate pain (and definitely for severe pain).
Rapidly titratable analgesic medications are most likely to be used with _
The most common side effect of opioid administration is _, and it can be lessened through the use of _
Constipation; a prophylactic bowel regimen.
1. A physiologic *protective mechanism* that helps the body become accustomed to a medication so that adverse effects (*except for constipation*) gradually diminish.
2. Characterized by a *decrease* in one or more therapeutic effects of the medication (e.g., less analgesia) or its adverse effects (e.g., nausea, sedation, or respiratory depression).
Tolerance to analgesia usually occurs during the first _ to _ of therapy.
Several days to 2 weeks.
1. A *normal physiologic response* manifested by the development of *withdrawal symptoms* upon sudden discontinuation of a medication.
2. The best approach is to gradually reduce the dose of the medication, rather than abruptly discontinuing the drug.
3. *Not necessarily* an indicator of addiction; rather, it indicates that the drug is medically necessary for managing symptoms.
*Dependence* is likely to occur when an opioid has been administered repeatedly for more than _
1. A *chronic disease* with biologic, neurologic, and psychological characteristics related to a particular drug.
2. Marked by craving, compulsive use, inability to control use, and continued use even when harm occurs.
3. *Rarely occurs* in relation to analgesic medications; patients may need to be reassured that the risk is minimal.
Tolerance and dependence are normal responses that should be expected when opioids are taken for _ to _ or longer.
2 to 4 weeks.
_ of Americans age 65 and older die *in hospitals*, although more than _ state their desire to die *at home*.
_ is a philosophy of care with the goal of supporting dignified dying and a good death experience for terminally ill patients and their families.
End-of-life supportive interventions - *presence*
1. A "gift of self" in which the nurse is available and open to the situation.
2. Demonstrated through verbal communication, valuing what the patient says, accepting the patient's meaning of things, and remembering or reflecting.
End-of-life supportive interventions - *compassion*
The nurse strives to be totally and compassionately *with* the patient and their family, allowing the most positive experience.
End-of-life supportive interventions - *touch*
1. A powerful therapeutic intervention, it communicates an offer of unconditional acceptance.
2. It can be both healing and life affirming, a means of communicating genuine care and compassion.
End-of-life supportive interventions - *recognition of autonomy*
The nurse realizes and respects the individual's right to make all end-of-life decisions.
End-of-life supportive interventions - *honesty*
1. The nurse is often in a front-line position to communicate/explain what can be expected.
2. Builds trust with the older adult facing death and his or her family.
End-of-life supportive interventions - *expert communication*
Nurses need to be able to assess the patient and family, implement a plan to comfort them, and communicate clearly and supportively throughout.
End-of-life supportive interventions - *assisting in transcendence*
At the highest level of care, nurses provide emotional support that facilitates the experience of self-transcendence and a sense of triumph over death.
Communicating with dying patients and their families - what *to say*
1. "What do you need me to do for you?"
2. "Is there anyone I can call for you?"
3. "I'm here to listen."
4. "No need to rush. Take your time."
5. "It's okay to cry. Let me get you a tissue."
6. "Would you like to be left alone?"
7. "Would you like to share some memories?"
Communicating with dying patients and their families - what *not* to say
1. "She's in a better place now."
2. "He lived a full life."
3. "She's out of her pain."
4. "It'll be all right."
5. "Don't cry."
6. "Be strong."
7. "He'd want you to get on with your life."
The most popular pain intensity scales used with older adults are _
1. The Numeric Rating Scale (NRS) - 0-10 rating; most popular scale.
2. The Verbal Descriptor Scale (VDS) - ideal when cognitive impairment is present; patient describes their pain as "no pain," "mild," "moderate," "severe," or "pain as bad as it could be."
3. The Faces Pain Scale-Revised (FPS-R) - best for use when language/communication barriers are present, but considered the weakest in terms of validity.