Palliative And EOLC

Question 1

Specialized care provided to patients with serious Illness with a goal of managing symptoms and helping patients to cope with their illnesses

Answer 1

Palliative care

Question 2

A Medicare defined insurance benefit and is a form of palliative care that is focused on caring for patients with a life expectancy of 6 months or less

Answer 2

Hospice care

Question 3

What are the 5 common disease that cause patients to receive palliative care?

Answer 3

1. Cancer
2. HF
3. COPD
4. Organ failure ( liver or renal)
5. Neurologic diseases

Question 4

What are 6 symptoms that need to be managed in palliative care?

Answer 4

1. Pain
2. Constipation
3. N/V
4. Anxiety
5. Delirium
6. Dyspnea

Question 5

What 4 things are used for a patient to be eligible for hospice care?

Answer 5

1. Opinion of two physicians that agree the natural course of their disease will result in death in 6 months
2. The hospice medical director determines and documents the terminal diagnosis
3. Hospice medical director recertification eligibility at defined intervals
4. Specific criteria based on hospice diagnosis must be met

Question 6

What PPS score is appropriate for hospice?

Answer 6

70% or less

Question 7

What are 3 common tools used to assess the quality of life in hospice?

Answer 7

1. Palliative Performance Score
2. ECOG
3. FAST Scale

Question 8

What tool describes a patients level of functioning in terms of ability to care for themselves?

Answer 8

ECOG

Question 9

What tool assesses a patients ability to function and determine how to move toward end of life?

Answer 9

PPS

Question 10

What tool identifies the progressive activity limitations associated with Alzheimer’s disease?

Answer 10

FAST Scale

Question 11

What are the 7 drugs that have potential harmful effects and no short term benefit?

Answer 11

1. Statins
2. Antihypertensives
3. Antiglycemics
4. Vitamins
5. GI prophylactics
6. Aspirin primary prevention
7. Osteoporosis medications

Question 12

When is hospice expected to pay for all medications?

Answer 12

For all medications related to the primary or secondary diagnosis or prognosis of 6 months or less to live

Question 13

Who is eligible for palliative care?

Answer 13

Anyone with a serious long term illness regardless of the stage

Question 14

Who is eligible for hospice care?

Answer 14

Anyone with a terminal illness whose doctor determines they have less than 6 months t9 live

Question 15

Can patients still get curative treatment when they are in hospice care?

Answer 15

No

Question 16

How long can patients stay with palliative care?

Answer 16

Depends of insurance coverage

Question 17

How long can patients stay with hospice care?

Answer 17

As long as the patient is eligible

Question 18

When can palliative care start?

Answer 18

When a diagnosis is received

Question 19

When can a patient get started on hospice care?

Answer 19

When the illness is terminal or life limiting

Question 20

What are the 3 “early” signs for a predictive value of death in 3 days?

Answer 20

1. Decreased level of consciousness
2. Decreased performance status
3. Dysphagia of liquids

Question 21

What are the 4 main medications used for end of life care?

Answer 21

1. Morphine
2. Lorazepam
3. Haloperidol
4. Atropine/scopolamine/glycopyrrolate

Question 22

What is preferable for patients with persistent nociceptive pain?

Answer 22

Scheduled around the clock analgesics

Question 23

What is the opioid conversion for Morphine (ORAL: IV/SQ)

Answer 23

3:1

Question 24

When switching from morphine to another analgesic, what should you do to the dose?

Answer 24

Decrease dose by 25-50% when switching to another opiate

Question 25

What are the 7 non pharmacologic interventions?

Answer 25

1. Music 2. Aromatherapy 3. Massage 4. Touch 5. Active listening 6. Therapeutic presence 7. Empathy