Flashcards in Palliative Med last lecture Deck (67):
What is the split (%) between sudden vs slow death?
Why are we so valuable at the end of life?
Have experience with death
What makes preparing for the last hours of life difficult? (2)
Time course is unpredictable, and hard to anticipate needs
What should do if the patient wants to die at home?
Regularly review plan of care
What are our responsibilities for preparing for death?
Aware of pts choices
True or false: there is less interesting in communication with the world near the end of life
What happens to nutritional intake before death?
True or false: pts near death are usually lethargic
False- usually restless
True or false: pts near death are usually lucid
False- altered states of consciousness
True or false: pts are usually quiet and reflective near the end of death
True or false: sleeping and waking hours are often messed up near death
What happens to breathing near death?
Decreased to apnea for some time
Why does gurling occur near death?
Lung secretions not cleared
True or false: a surge of energy can occur just prior to death
What happens to the skin near death?
What happens to their level of awareness when death is imminent
What happens to the eye near death
Stop blinking so much
What is ICHABOD syndrome (near death symptoms)?
Oral intake decreased
Fever near death is caused by what?
Failure of hypothalamus to regulate temperature well--NOT infx
Why do we care about immobility in the near death pts (besides emboli)?
Joint position fatigue
How can anorexia be protective?
Risk of aspiration
What are the three ways of saying no to food?
What makes food nauseating at the end of life?
Low blood flow to GI tract
How do we help the family deal with pt anorexia?
Find some other way to nurture the pts
What is the difference between body shutting down and starvation? (3)
Absence of hunger
Loss of electrolytes
Decreased GI tract blood flow
Where is the locus of sensation of thirst, taste and hunger?
Hunger = stomach
Thirst and taste = mouth
Why are liquids so important?
What are the questions that should be asked with artificial hydration?
-Is pts well being enhanced?
-Aggravation of symptoms
True or false; Dehydration does not cause distress
What is the MOA of dehydration protection?
How can parental fluids be harmful?
What is the first sign of decreasing blood perfusion? Two others?
Mottling of skin
True or false: parental fluids do not reverse decreasing blood perfusion
True--just makes fluids go where you don't want them
What is the last sensation to be lost during LOC?
What happens to breathing with LOC?
Changes (rapid to deep).
What happens to sphincter control near death?
Loss of control
True or false: periods of apnea come and go near death
What are the two roads to death?
Difficult road = progression to crazy, before szs and coma
Easy = slowly lose consciousness
True or false: drs do not be a part of the road to death
Not if there's nurses or other ppl to provide info
True or false: typically, dying is peaceful
How do you test for decreasing LOC?
True or false: awareness > ability to respond?
True or false: you should assume that the pt hears everything
What type of questions should you asking near death pts?
Binary (yes or no)
How can you increase communication with the unconscious pt?
-Create familiar environment
-assure safety of pt
When should family give permission to die?
When they mean it
True or false: pts near death have a heightened bullshit radar
How do you manage terminal delirium?
What is the drug of choice for seizures in the dying pts? Why?
Valium--does not stop szs, just stops tonic-clonic movement
What are the changes in respiration? (3)
Diminishing tidal volume
What are the last reflex breaths?
Gasping breath after the last
Are accessory muscles used often or less so at the end?
What are the common fears with changes in respiration?
When can oxygen be helpful? When can it hurt?
Comfort for family
Bed if proloning death
What happens to swallowing near the end of death? (2)
Loss of gag reflex
Build up of secretions
What is postural drainage?
Allowing secretions to drain through positioning
True or false: suctioning is often indicated to control secretions near death
What is the drug of choice to dry secretions?
What are the signs of pain?
What do you need to distinguish pain from?
When should opioids be decreased?
With renal function
How should opioids be given near the end of life?
Least invasive route
True or false: pads for drug admin is useful at the end of life
True or false: IM routes should be avoided at the end of life
True or false: you should still give all usual meds near end of life to ensure routine
True or false: what the pt experiences is not the same as what onlookers see