Week 4 - Palliative - Part 2

Question 1

What are the 5 domains of quality EOL care?

Answer 1

1. Receiving adequate pain and symptom management
2. Avoiding inappropriate prolonging of dying
3. Achieving a sense of control
4. Relieving burden (to others)
5. Strengthening of relationships with loved ones

Question 2

What are the 5 most prevalent symptoms in palliative care?

Answer 2

Dyspnea, constipation, fatigue, pain, delirium

Question 3

unpleasant sensory awareness of breathing; subjective experience of difficulty or uncomfortable breathing

Answer 3

Dyspnea

Question 4

What pharmacologic agents are used in the management of dyspnea?

Answer 4

Aerosol corticosteroids and bronchodilators
in the palliative patient, opioids (e.g. morphine/hydromorphone) can help steady breathing and take away air hunger

Anxiolytics - Haldol or BDZs

disease specific:
COPD - nebulizer
CHF lung congestion - Lasix, glycopyrolate (not too early)

Question 5

Why don’t we want to give glycopyrolate too early in CHF patients?

Answer 5

Might dry up secretions and create a mucus plug

Question 6

What is another word for haldol?

Answer 6

vitamin H

Question 7

Why is Haldol given for dyspnea in the palliative patient?

Answer 7

Anxiety is usually the largest factor that causes dyspnea

Question 8

What are some non-drug interventions for dyspnea?

Answer 8

DB&C, meditation, music therapy, raising HOB, chest physio
push ribcage as patient is breathing to push out mucus
humidified nasal prongs

Question 9

How does one screen for constipation?

Answer 9

Auscultate for bowel sounds
check for abdominal distension
ask about last BM

Question 10

Describe the prevention of constipation.

Answer 10

Get them up and moving
Preventing it by using laxatives (oral first, then PR)
fibre and fluids (metamucil, prune juice)

Question 11

What are pharmacologic agents to treat constipation?

Answer 11

Laxatives, lactulose, senna, peglyte, etc.

Question 12

When will a suppository not work?

Answer 12

When the stool is not right there when you put it in

Question 13

What are some non-drug ways to manage constipation?

Answer 13

Ambulation, prune juice, digitally removing stool (if a doctor’s order is present and their condition warrants it)

Question 14

What are ways to screen for fatigue?

Answer 14

Asking about their energy levels and sleep schedules

Question 15

What are ways to manage fatigue pharmacologically?

Answer 15

Haldol for deeper sleep
lowering haldol dose when they want to be awakre
(caffeine - but careful about constipation)

Question 16

What are non-pharmacological ways to manage fatigue?

Answer 16

Encouraging sleep

Talk to them, get them up to a window, etc.

Question 17

What is one of the most feared and incapacitating symptoms among patients facing the end of life?

Answer 17

pain

Question 18

Pain is what….

Answer 18

the patient says it is

Question 19

What is the OPQRST acronym?

Answer 19

Onset, palliation/provocation, quality, radiation, severity, time

Question 20

For palliative patients, is it detrimental to give pain meds when you see them furrowing their brow or when they say they are in pain?

Answer 20

No - never think that if you give the next dose of hydrophone you will kill them
(focus on QOL and pain management - if q2 but only 1hr and a half passed - call physician for pain meds)

Question 21

What are some non-pharmacological pain aids?

Answer 21

o	Heat or cold packs
o	Extra pillows
o	Warn blanket
o	Guided meditation
o	Dogs/pets
o	Closing blinds, turning lights off – for migraines
o	Keeping noise at a minimum
o	Keeping them on their favourite side

Question 22

A cognitive disturbance resulting from an altered mental state, described in terms of disrupted consciousness and impaired cognition (thinking, perception, memory)

Answer 22

Delirium

Question 23

What is another word for delirium?

Answer 23

Terminal restlessness

Question 24

What are common causes of delirium?

Answer 24

o	UTI/infections
o	New location
o	Med interactions
o	Pain
o	Electrolyte imbalances
o	Head injury
o	Tumour
o	Bleeds

Question 25

How does one assess for delirium?

Answer 25

History Delirium chart asking a family member

Question 26

What are some considerations for ABx use in palliative patients who may be delirious?

Answer 26

If they are close to death, better to just give antibiotics rather than try to determine agent - especially if blood cultures are needed

Question 27

What is a drug often given for delirious patients?

Answer 27

Haldol

Question 28

What are non-pharmacological ways to manage delirium?

Answer 28

Reorient if possible music talking through it

Question 29

What is the number one takeaway for delirious patients?

Answer 29

Safety first - make sure the patient is safe - use family members, restraints or bed alarms as necessary

Question 30

What are some societal factors that are leading nurses of all floors to need to understand palliative care?

Answer 30

Both kids are working and cannot care for parent People are living longer and have more complex conditions Aging population Trajectories of death - e.g. CHF

Question 31

What are some complementary therapies?

Answer 31

Herbal therapies, manual therapies like reflexology and acupuncture

Question 32

Describe FNs healing Canadian Cancer society

Answer 32

Holistic approach to health integrates traditional healing practices - e.g. special ceremonies, rituals and herbals FNs healers believe that the body, mind and spirits must work in harmony and balance to be healthy

Question 33

Can smudging ceremonies occur in the hospital?

Answer 33

No, would need to find another area since the scent-free policy wins

Question 34

Describe a good death.

Answer 34

* Free from avoidable distress and suffering for patient, family and caregivers * Patient’s and family wishes met * Consistent with clinical, cultural and ethical standards

Question 35

What are some reasons that it is hard to talk about EOL decisions?

Answer 35

* People don’t like to talk about death * Fear of giving up * Don’t know options available to them * Uncertainty about client wishes * Cultural, spiritual and religious traditions * Previous experiences with death * Emotional component

Question 36

What are the requirements for MAID?

Answer 36

* Competent adult person * Clearly consents to the termination of life * Not the result of outside pressure * The patient must be suffering from a terminal illness in an advanced state of decline and cannot be reversed * Pt must be suffering unbearably