Palliative Care

Question 1

What are some myths in palliative care?

Answer 1

PC=giving up hope, child must be terminally ill/at end of life to have PC, only for kids with cancer, child must have DNR to have PC, must abandon disease-directed treatment, child will die sooner, and administering opioids respiratory depression/quickens death

Question 2

Consequences of myths?

Answer 2

Labelling (don’t label pt as palliative), PC fosters “doing nothing”, leads to feelings of isolation/abandonment, seems like last resort, feels like giving up, and makes DNR a big issue

Question 3

What is PC?

Answer 3

Approach that improves quality of life of pt/their families facing life threatening illness through prevention and relief of suffering

Question 4

What is pediatric PC?

Answer 4

Combo of active/compassionate therapies to comfort and support children and families living with life threatening illness. Also to provide framework for discussion of balancing benefits/risks

Question 5

What is a life threatening illness in peds and types?

Answer 5

Conditions where survival to adulthood is a challenge.
Malignancies (cancer), respiratory (cystic fibrosis), CNS degeneration (MS), CNS abnormality (anencephaly- no brain, cerebral palsy), syndromes (trisomy, chromosome deletions), CVS (heart defects), neuromuscular (duchene muscular dystrophy), metabolic, and transplants (lung, small bowel)

Question 6

T or F? PC likes to be involved early on at time of dx

Answer 6

Yes

Question 7

New paradigm for PC?

Answer 7

PC is a benefit long before death, benefits pt with life threatening illnesses, care extends beyond death/includes families, and there is want from shift in care from hospital to home (not always possible)

Question 8

What do families want from PC?

Answer 8

Positive relationships with HCP, ongoing info, good pain management, contact after child’s death, cultural awareness, support for siblings, and care setting of their choice

Question 9

What is the role of PC?

Answer 9

To work with primary physicians/care teams, assist with communication, pain/symptom management, formulate care plans, transitions to home, bereavement follow up, and focus on living well

Question 10

Resuscitation guidelines?

Answer 10

1. Early discussions is most helpful to children/families- discuss prognosis, elicit goals of care
2. Recommend- what would be care vs what would not be good care

Question 11

What is perinatal PC?

Answer 11

PC for moms expecting a child with life threatening/limiting illnesses (congenital anomalies, overwhelming illness, suffering from treatment). Period is 20-28 GA to 1-4 weeks PP.

Question 12

What is a birth plan?

Answer 12

The mom’s wish list for their birth. Includes medical/non- medical goals r/t delivery, medication, resuscitation guidelines, feeding goals, and spiritual needs

Question 13

What’s included in assessment for PC?

Answer 13

Physiological assessment (VS, pain, physical stuff), psychosocial assessment (body image, stress, coping, support), and do a developmental assessment

Question 14

What is pain?

Answer 14

Unpleasant sensory/emotional experience associated with actual/potential tissue damage

Question 15

Nociceptive pain vs neuropathic pain? and what they feel like

Answer 15

Noc- damage to underlying soft/bone tissues by disease. Can either be somatic (localized, sharp/throb/squeeze/ache) OR visceral (diffuse, poorly localized, dull/cramp)

Neuro- invasion/traction on nerves arising from injury to CNS or PNS, causes burn/sting/tingle/prickly/stab

Question 16

Myth/obstactles to treating pain?

Answer 16

Fear of giving up, opioids are “too strong for kids”, fear of SE, worry child will become addicted, cultural/religious beliefs, lack of education, lots of fear about opioids

Question 17

4 types of pain assessment tools for kids?

Answer 17

1. CRIES- used for infants post op pain (crying, requires O2 for SpO2 <95%, increased VS-BP/HR, expression (grimace), sleeplessness)
2. FLACC- used for 2 mos to 7 yrs )face, legs, activity, cry, consolability)
3. Wong Baker FACES- used for >3-4 yrs old (shows a bunch of cartoon faces for kid to point at)
4. Numerical rating/visual analog scale- used for older kids

Question 18

Commons meds used for peds pain management?

Answer 18

NSAIDs, Tylenol, codeine, morphine, hydromorphone, fentanyl, methadone, ketamine,, adjuvants

Question 19

WHO analgesia ladder?

Answer 19

1. First used non opioids and adjuvant
2. Opioid for mild to moderate pain, can also used non opioids and adjuvants
3. Opioids for moderate to severe pain, can also use non opioids and adjuvants

Question 20

Opioid common side effects?

Answer 20

Constipation, N/V, pruritus, respiratory depression (for very high doses), confusion/hallucinations, myoclonus (constant twitching/jerking), and somnolence (very sleepy)

Question 21

When should you consult PC?

Answer 21

When there is a life threatening or life limiting illness at any age. Early involvement is crucial

Question 22

4 concepts for pain management?

Answer 22

1. By the ladder
2. By the clock
3. By the mouth
4. By the child (treat child’s pain not the parents)