Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 205 > lecture 20: palliative care > Flashcards

lecture 20: palliative care Flashcards

1
Q

what is palliative care

A

approach to care that aims to improve quality of life of person’s and their families facing problems associated w life-limiting

palliative care is provided at the same time as curative care, maximizing quality of life throughout the course of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when does palliative come into play

A

when all interventions have been tried

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

words to avoid in palliative

A
  • he’s palliative / she was made palliative
  • are they palliative now?
  • there’s nothing more we can do
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

is “being palliative” a diagnosis

A

no!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

preferred words for palliative pts

A
  • he has palliative care needs
  • we are now using a palliative approach to their care
  • goals are symptom-directed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

6 components of a good death

A
  • accepted
  • good sympt control
  • planned
  • adequate support/resources
  • appropriate setting and site
  • in keeping w pt wishes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

goals of care for palliative pts

A
  • guide the convo
  • what is ur understanding w where ur illness it @
  • how much info would you like shared
  • if your health worsens what are your most important goals
  • what are ur biggest fears and worries w ur health
  • act on the convo
  • etc…
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how is SDM determined

person who is/are highest on this hierarchy

A
  • attorney for personal care
  • spouse or partner
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

2 screening and assessment tools for palliative

A
  1. edmonton sympt assessment sys
  2. palliative performance scale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

if no SDM is identified who acts as the SDM

A

the public guardian and trustee (treatment decisions unit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what can we do at EOL

A
  • make family and treating team aware of changes in final stages
  • treating goal is to minimize discomfort
  • anticipate and identify pt and family needs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

4 aspects of dying

A
  1. social (distancing; withdrawal)
  2. emotional (fluctuations; existing concerns)
  3. spiritual (suffering; existential concerns)
  4. cultural (rituals; ceremonies; information sharing)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the sympt prevalence in final days

dyspnea:
secretions:
delirium:
families who would be grateful for support and guidance:

A

dyspnea: 80%+
secretions: as high as 92%
delirium: 80%+
families who would be grateful for support and guidance: 100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

signs of death

A
  • urine output decreases and may become tea-coloured
  • decreased awareness, insight and perception
  • HR increased irregular and thready
  • sleeping increases
  • eating or drinking sto[
  • eyes might b slightly open
  • oral and ocular mucosal dryness
  • breathing shallow, apnea, terminal secretions
  • change in skin temp and colour
  • restlessness and agitation
  • incontinence of urine and stool may occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

visceral pain examples

A

cramping, twisting, sore, bloating, aching, throbbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

somatic pain examples

A

sharp, sore, aching, stabbing

17
Q

neuropathic pain

A

burning, numb, tingling, pins and needles, etc

18
Q

is most pain visible

A

no its mostly under the surface like an iceberg

19
Q

somatic pain pharmacological treatments

A

NSAIDS
opioids
bisphosphonates
calcitonin
chemo
dexamethasone

20
Q

somatic pain
(other modalities)

A

radiotherapy
splints/braces
surgical fixation
positioning +/- support surfaces

21
Q

what is neuropathic pain

A
  • caused by injury to nerve tissue, either central or peripheral and could include the ANS
  • burning, tingling/numbness
22
Q

pharmacologic options for neuropathic pain

A
  • TCA (amitriptyline)
  • anticonvulsants (baclofen, gabapentin)
  • dexamethasone
  • opioids
  • methadone
23
Q

other modality options for neuropathic pain

A
  • acupuncture
  • nerve blocks (intercostal, celiac plexus)
24
Q

mild pain cancer management (1-3/10)

A
  • non-opioid
  • +/- adjuvant
25
Q

moderate pain cancer management (4-6/10)

A
  • weak opioid (codeine, tramadol)
  • +/- adjuvant
26
Q

severe pain cancer management (7-10)

A
  • strong opioid

1st line: morphine, oxycodone, hydromorphone

2nd line: fentanyl

3rd line: methadone

+/- adjuvant

27
Q

EOL facts about opioids

A
  • not every dying pt has pain, however if they are pain can be controlled
  • in right doses opioids control sympt not hasten death*
  • when titrated properly, resp depression is not a concern in a dying pt
  • decreased LOC is expected at EOL; continue the opioid to ensure comfort
28
Q

pharmacologic ways for managing dyspnea

A
  • supplemental o2 is recommended for hypoxic pts w dyspnea
  • supplemental o2 is NOT recommended for non-hypoxic dyspneic pts, but is may be given for comfort, prn
  • systemic opioids can be used to decrease sensation of SOB in advanced cancer pts
29
Q

goals for terminal delirium at EOL

A
  • result of metabolic encephalopathy resulting from organ failure, electrolyte imbalance, nutritional abnormalities or sepsis
  • often distressing for families to witness; teaching and reassurance is needed
  • goal is to control the distress, not to correct cause
  • normalize the behaviour for the family
30
Q

how do you treat terminal delirium

A
  • trial prn analgesic and assess response
  • if analgesic ineffective, trial one dose of antipsychotic and assess response
31
Q

what to do for secretions in EOL

A
  • positioning
  • meds
  • suctioning
32
Q

circulation in EOL

A
  • extremities usually get colder to touch
  • BP lowers and HR may increase, but get weaker
  • skin becomes waxy and pale
  • fingers, lips, nail beds may look bluish (cyanosis)
  • mottling: puplish or blotchy red-blue colouring on knees and/or feet
33
Q

interventions for circulation problems in EOL

A

keep pt warm w light blankets
turn pt every 2 hrs if warranted

34
Q

metabolism/dehydration of pt in EOL

A
  • decreased intake orally
  • eventually unable to swallow
  • decreased appetite
  • pt often doesn’t feel hunger
35
Q

what happens if you misinterpret sympt of agitation, restlessness, and moaning in a pt w terminal delirium

A

potentially aggravate sympt and cause opioid neurotoxicity

36
Q

interventions for pt w metabolism/dehydration problems in EOL

A

ice chips/sips of fluid
swab mouth w cool water

NURS 205 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions