Non-Pain 1 Flashcards Preview

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Flashcards in Non-Pain 1 Deck (23):
1

When managing non-pain symptoms, should choose treatment strategies that support the patient's goals of care

- Age
- Functional Status
- Overall Needs
- Rate of change of the disease
- Life expectancy

2

Don't treat the symptoms, treat the _____ of the disease whenever possible

CAUSE

3

Goal setting with Geriatrics

- Are the goals achievable?
- Are the goals beneficial?
----extend life or improve comfort?
- How will the results be measured... timeframe to reassess and decide whether to continue or stop the intervention.

4

Most common non-pain symptoms in palliative care

- Constipation
- Nausea and vomiting
- Diarrhea
- Bowel Obstruction
- Anorexia and Cachexia
- Delirium
- Depression
- Dyspnea

5

Dyspnea is common is which diseases?

- Cancer
- COPD
- HIV/AIDS
- CHF
- ALS
- Dementia

- Tends to worsen as death approaches

6

Assessing Dyspmea

- Dyspnea is SUBJECTIVE
- Self-report the gold standard
- RR, signs of increased WOB, oxygen saturation, and other tests DON'T correlate with patient reporting dyspnea
- Rx is dependent upon prognosis, goals of care, risks and benefits of tests/interventions

7

Causes of Dyspnea

BREATH AIR mneumonic
- Bronchospasm
- Rales
- Effusion
- Airway obstruction
- Thick Secretions
- Hemoglobin is low
- Anxiety
- Interpersonal issues
- Religious concerns

8

Treatment for Dyspnea

- Oxygen
- Opioids (first line)
- Anxiolytics (treat anxiety, not dyspnea)
- General Measures
- Alternative, Complimentary- things like acupressure, acupuncture, meditation, massage
- Non-invasive ventilator support (CPAP)

9

General, non "medical" interventions for treating dyspnea

- Reduce exertion/energy expenditure
- Reposition the patient- upright or the compromised lung down
- Provide skin care for the buttocks
- Improve air circulation
- Address anxiety and provide reassurance
- Discuss any patient, family, or staff concerns about using opioids to relieve dyspnea

10

General things to assess with Dysphagia

- "difficulty swallowing"
- Discern whether it is neurologic or non-neurologic---- things like solids progressing to liquids (obstruction) and simultaneous solids and liquids (neurologic)
- Conservative management can ameliorate dysphagia for the majority of patients
---- emphasize good oral hygiene

11

Reversible causes of anorexia

- Aches and Pains
- Nausea and GI dysfunction
- Oral Candidiasis
- Reactive (or organic) depression
- Evacuation problems (constipation, retention)
- Xerostomia (dry mouth)
- Iatrogenic (radiation, chemo, drugs)
- Acid-related problems (gastritis, peptic ulcers)

12

Anorexia Treatment

Appetite stimulants-
-- megestrol Acetate
-- Corticosteroids
-- Eicosapentaenoic acid
-- Thalidomide
-- Cannabinoids
Artificial Nutrition and Hydration
-- Enteral feedings (tube)
-- Parenteral feeding
-- The benefits of artificial nutrition for palliative care patients are difficult to identify

13

Reframing Requests for artificial Hydration and Nutrition

- Validate their concern
- Suggest other alternative interpretation
- share more info and give alternative explanation and suggestions

14

Nausea and Vomiting- General

- In seriously and terminally ill patients, these two symptoms are extremely common.
- Nausea and vomiting can cause significant distress
- Can usually be controlled in over 90% of patients

15

Treatment strategies for Nausea and vomiting

- Select an antiemetic agent based on the likely cause, pathway mediating the symptoms, and neurotransmitters involved
- Other general measures, like small and frequent meals, frequent small sips of fluids, avoiding strong odors or unpleasant tastes, and address nonphysical symptoms like psychological, social, and spiritual

16

Malignant Bowel Obstruction

- 1/2 of ovarian and GI cancer patients have this
- Patients diagnosed with this have a median survival of 3 months
- High symptom burden

17

Treating Malignant Bowel Obstruction

- Management dependent upon functional status, goals of care, expected survival

- Surgical- limited evidence of the benefit and QoL
- Endoscopic techniques- stents (if single point of obstruction)
- Medical management- the mainstay of Rx

18

Delirium signs/symptoms

- Acute Onset
- Fluctuating
- Altering levels of consciousness- hyperactive, hypoactive, or mixed
- Cognitive impairments
-- Altered orientation
-- Altered organization of thought
-- Altered perceptions
-- memory impairment

19

What causes Delirium in elderly patients

THE HUGE ONE- MEDS!!!!!
- other are infection, constipation, urinary retention, and uncontrolled pain

20

Assessing Delirium

- Identify potentially reversible causes
- Treat underlying cause
- Use low dose non-sedating antipsychotics
- AVOID benzodiazepines- and NEVER use without an antipsychotic

21

Issues with delirium

- High incidence
- VERY distressing to patients and family members
- Cause of discord between family members and health care professionals
- aggressive preventative measures

22

Preventative Measures for Delirium

- Prevent dehydration
- Remove unnecessary catheters/IVs, restraints
- Reduced light and sound at night with minimal interventions
- Decrease environmental stimuli
- Sleep, music, massage

23

Key points from this lecture!!

- Most patients receiving palliative care have multiple symptoms
- Screening assessment is key to identifying the symptom constellation
- Detailed history and comprehensive PE are needed to determine most probably cause
- Treatment strategies should be determined by the patient's goals of care and directed at treating the underlying cause whenever possible!