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NURS 470 > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

characteristics of hospice

A

neither prolongs or hastens death
improve quality of patient’s last days
care is delivered by an interprofessional team using a holistic approach
must forgo curative treatment
medical prognosis of 6 months or less

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2
Q

EOL care domains

A

patient & family-centered decision making
communication
continuity of care
emotional and practical support
symptom management and comfort care
spiritual support
emotional and organizational support for clinicians

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3
Q

POLST

A

provider order for life-sustaining treatment
CPR or AND
full code or modified
medically assisted nutrition

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4
Q

common symptoms at EOL

A

pain
fatigue/weakness
GI: anorexia, cachexia, N/V/D, constipation, dysphagia
respiratory: dyspnea, cough
Skin: pruritus, sweats, wounds
Psychological: anxiety, depression, delirium
lymphedema, insomnia

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5
Q

5 wishes

A
  1. who i want to make decisions
  2. what treatment i want
  3. how comfortable
  4. how i want to be treated
  5. what i want my loved ones to know
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6
Q

legacy making

A

am i important in this life?
did my life make a difference?
will i be remembered?
what will i be remembered for?
making memories
reminiscence therapy
storytelling

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7
Q

4 symptom management outcome

A

physical well-being: symptoms
social: social support, relationships
psychological: anxiety, depression
spiritual: values & beliefs, meaning & purpose

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8
Q

general symptom assessment using multidimensional approach

A

body: physiologic, sensory
mind: emotional, cognitive, behavioral
spirit: meaning, purpose

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9
Q

Tier 1 of Tiered Approach to Symptom Management

A

mind-body therapies
nutritional therapies
natural products
supplements
integrative nursing therapies

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10
Q

tier 2 of Tiered Approach to Symptom Management

A

movement therapies
nutritional therapies
natural products and herbs

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11
Q

tier 3 of Tiered Approach to Symptom Management

A

mind-body therapies
energy therapies
health coaching
manipulative therapies

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12
Q

tier 4 of Tiered Approach to Symptom Management

A

whole systems (like CM)

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13
Q

tier 5 of Tiered Approach to Symptom Management

A

pharmacological therapies
psychotherapy/behavioral therapy
other invasive therapies

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14
Q

symptoms associated with pain

A

constipation
fatigue
nausea
fear
anxiety
urinary retention
ineffective breathing pattern

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15
Q

factors of pain management in older adults

A

physiological changes: pain perception, organ function decline
pain experience: history, chronic illness
psychological factors: fear of addiction/complainer, anxiety, depression
comorbidities
polypharmacy
geriatric syndromes: delirium, falls
impact of pain on ADLs and iADLs
perception that pain is normal

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16
Q

barriers to pain management

A

fear of addiction
tolerance to opioids
failure of staff to assess & document pain
lack of access to adequate treatment
view pain as expected r/t disease
lack of administration of appropriate analgesics
inadequate knowledge about pain management
legal issues

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17
Q

tolerance

A

larger doses are needed over time to produce the same analgesic effect

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18
Q

physical dependence

A

continued drug use is required to prevent withdrawal symptoms

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19
Q

addiction

A

behavior pattern which demonstrates the psychological need for opioid

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20
Q

types of pain

A

HA d/t ICP
acute spinal cord compression
SVC syndrome
metastatic bone pain
arthritic pain (RA)
pain d/t organ enlargement

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21
Q

therapeutic effects of corticosteroids

A

anti-inflammatory, increases appetite, elevates mood, suppresses nausea

22
Q

side effects of corticosteroids

A

oral candidiasis, edema, Cushingoid syndrome, dyspepsia, water weight gain, ecchymoses, hyperglycemia, myopathy, neuropsych changes

23
Q

bladder spasm pain meds

A

oxybutynin
prostaglandins

24
Q

rectal spasm pain meds

A

diltiazem
clonidine
benzodiazepines (lorazepam)

25
Q

meds for colicky pain d/t bowel obstruction

A

scopalamine
octrotide

26
Q

bone pain meds

A

NSAIDs: acetaminophen, aspirin, naprozen, ibuprofen, ketoprofen, keterolac
corticosteroids
biphosphonates

27
Q

neuropathic pain characteristics

A

numbness, tingling, pins, needles
lancinating, shooting, shock-like

28
Q

neuropathic pain meds

A

antidepressants: tertiary amine tricyclic and secondary amine tricyclic drugs
anticonvulsants: carbamazepam, gabapentin
long-term systemic local anesthetic
topical anesthetic
clonidine, baclofen, calcitonin, ketamine, clonazepam

29
Q

symptoms associated with pain management by opioids

A

circulatory depression
urinary retention
cutaneous effects: pruritus, flushing, sweating
respiratory depression

30
Q

fatigue

A

overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work
tired, lack of energy, exhausted, heavy, slow

31
Q

fatigue etiology

A

chronic, unrelieved symptoms
treatment-related
infection
malnutrition
endocrine disorders (Hypothyroidism)
anemia
sleep pattern disruption/poor sleep quality

32
Q

nausea and vomiting etiology

A

anorexia
constipation d/t decreased motility
spicy, unusual foods
dehydration
abdominal pain d/t bowel obstruction
meds: opioids, anti-infectives, chemotherapy d/t stimulation of CRTZ and VC

33
Q

constipation etiology

A

altered propulsion of contents, increased adsorption, decreased secretion, medications that decrease peristalsis

34
Q

constipation prevention

A

stool softeners/laxatives, fiber, hydration, exercise, routine toileting

35
Q

dyspnea etiology

A

narrowing of airways d/t bronchial constriction from swelling, tumor invasion or decreased alveolar function d/t fluid retention, tumor invasion
COPD, asthma
cancer
cardiopulmonary disease

36
Q

dyspnea manifestations

A

SOB, increased RR, gasping, wheezing, gurgling
tripod positioning
intercostal retraction
orthopnea

37
Q

dyspnea treatment

A

fanning/moving air, slow rhythmic breathing, pursed lip breathing
bronchodilators: albuterol, atrovent
corticosteroids: prednisone
opioid therapy: morphine

38
Q

pruritus etiology

A

cancer-related
polycythemia vera
renal and hepatic disease
allergic reaction
dehydration, dry environment
medications (opioids, anti-infectives)

39
Q

pruritus symptoms

A

severe itching, burning, numbness/tingling

40
Q

nonpharmacologic treatment of pruritus

A

humidifier, cool room temp, fans/moving air
cotton/loose clothing
hypoallergenic soap
avoid alcohol and spicy foods
hydration
keep skin lubricated

41
Q

pharmacologic treatment of pruritus

A

diphenhydramine
h2 receptor antagonist (ranitidine, cimetidine)
doxepin (TCA)
serotonin antagonist (ondansetron)

42
Q

delirium

A

non-specific cerebral dysfunction and LOC changes, thinking, memory, attention, & emotional disturbances;
develops over short time
50% reversible

43
Q

delirium etiology

A

meds (opioids, benzos)
hypoxia
dehydration
metabolic (hypercalcemia, hyponatremia)
sepsis
polypharmacy
ICP

44
Q

delirium assessment

A

CAM-ICU

45
Q

delirium treatment

A

treat reversible causes: change opioids, hydration, oxygen, bronchodilators, decrease number of meds
neuroleptics: haloperidol to manage agitation and hallucinations
benzodiazepines: lorazepam, midazolam
corticosteroids: manage cerebral swelling

46
Q

neurological indicators of imminent death

A

decreased verbal response, agitation, restlessness

47
Q

cardiac indicators of imminent death

A

increased/irregular HR
decreased BP
widening pulse pressure
dehydration

48
Q

pulmonary indicators of imminent death

A

increased RR
dyspnea
increased use of accessory muscles
Cheyne-Stokes respirations
noisy breathing

49
Q

GI indicators of imminent death

A

stool incontinence
nausea

50
Q

renal indicators of imminent death

A

urinary incontinence
decreased urine output

51
Q

mobility

A

limited
bedridden
needs frequent position changes

52
Q

stages of dying (loss) Kubler-Ross

A
  1. denial
  2. anger
  3. bargaining
  4. depression
  5. acceptance

NURS 470 (28 decks)

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