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Flashcards in Palliative Med last lecture Deck (67):
1

What is the split (%) between sudden vs slow death?

10% sudden
90% slow

2

Why are we so valuable at the end of life?

Have experience with death

3

What makes preparing for the last hours of life difficult? (2)

Time course is unpredictable, and hard to anticipate needs

4

What should do if the patient wants to die at home?

Regularly review plan of care

5

What are our responsibilities for preparing for death?

Aware of pts choices
Giving knowledge
Rapid respond

6

True or false: there is less interesting in communication with the world near the end of life

True

7

What happens to nutritional intake before death?

Decreases

8

True or false: pts near death are usually lethargic

False- usually restless

9

True or false: pts near death are usually lucid

False- altered states of consciousness

10

True or false: pts are usually quiet and reflective near the end of death

True

11

True or false: sleeping and waking hours are often messed up near death

True

12

What happens to breathing near death?

Decreased to apnea for some time

13

Why does gurling occur near death?

Lung secretions not cleared

14

True or false: a surge of energy can occur just prior to death

True

15

What happens to the skin near death?

Dusky'blotchy

16

What happens to their level of awareness when death is imminent

Little

17

What happens to the eye near death

Stop blinking so much

18

What is ICHABOD syndrome (near death symptoms)?

Immobility
Confusion
Homeostatic failure
Anorexia
Breathing changes
Oral intake decreased
Dyspnea

19

Fever near death is caused by what?

Failure of hypothalamus to regulate temperature well--NOT infx

20

Why do we care about immobility in the near death pts (besides emboli)?

Joint position fatigue
Decubitus ulcers
ADLs

21

How can anorexia be protective?

Risk of aspiration

22

What are the three ways of saying no to food?

Clench teeth
Push away
Say no

23

What makes food nauseating at the end of life?

Low blood flow to GI tract

24

How do we help the family deal with pt anorexia?

Find some other way to nurture the pts

25

What is the difference between body shutting down and starvation? (3)

Absence of hunger
Loss of electrolytes
Decreased GI tract blood flow

26

Where is the locus of sensation of thirst, taste and hunger?

Hunger = stomach
Thirst and taste = mouth

27

Why are liquids so important?

Xerostomia

28

What are the questions that should be asked with artificial hydration?

-Is pts well being enhanced?
-Aggravation of symptoms

29

True or false; Dehydration does not cause distress

True

30

What is the MOA of dehydration protection?

Releases endorphins

31

How can parental fluids be harmful?

Fluid overload

32

What is the first sign of decreasing blood perfusion? Two others?

Tachycardia
Peripheral cyanosis
Mottling of skin

33

True or false: parental fluids do not reverse decreasing blood perfusion

True--just makes fluids go where you don't want them

34

What is the last sensation to be lost during LOC?

Hearing

35

What happens to breathing with LOC?

Changes (rapid to deep).

36

What happens to sphincter control near death?

Loss of control

37

True or false: periods of apnea come and go near death

True

38

What are the two roads to death?

Difficult road = progression to crazy, before szs and coma

Easy = slowly lose consciousness

39

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

40

True or false: typically, dying is peaceful

True

41

How do you test for decreasing LOC?

Eyelash flick

42

True or false: awareness > ability to respond?

True

43

True or false: you should assume that the pt hears everything

True

44

What type of questions should you asking near death pts?

Binary (yes or no)

45

How can you increase communication with the unconscious pt?

-Create familiar environment
-assure safety of pt

46

When should family give permission to die?

When they mean it

47

True or false: pts near death have a heightened bullshit radar

True

48

How do you manage terminal delirium?

Benzos
Neuroleptics

49

What is the drug of choice for seizures in the dying pts? Why?

Valium--does not stop szs, just stops tonic-clonic movement

50

What are the changes in respiration? (3)

Diminishing tidal volume
Apnea
Chyene-stokes

51

What are the last reflex breaths?

Gasping breath after the last

52

Are accessory muscles used often or less so at the end?

More

53

What are the common fears with changes in respiration?

Suffocation

54

When can oxygen be helpful? When can it hurt?

Comfort for family
Bed if proloning death

55

What happens to swallowing near the end of death? (2)

Loss of gag reflex
Build up of secretions

56

What is postural drainage?

Allowing secretions to drain through positioning

57

True or false: suctioning is often indicated to control secretions near death

False

58

What is the drug of choice to dry secretions?

Scopolamine

59

What are the signs of pain?

Grimacing

60

What do you need to distinguish pain from?

Terminal delirium

61

When should opioids be decreased?

With renal function

62

How should opioids be given near the end of life?

Least invasive route

63

True or false: pads for drug admin is useful at the end of life

False

64

True or false: IM routes should be avoided at the end of life

True

65

True or false: you should still give all usual meds near end of life to ensure routine

False

66

True or false: what the pt experiences is not the same as what onlookers see

True

67

What are the two things you should discuss near death?

Status of pt/goals
Role of physician