Podcast
Questions and Answers
What is dyspnea?
What is dyspnea?
- An uncomfortable awareness of breathing that correlates with pulse oximetry and ABG
- A physiologic parameter indicating the rate of breathing
- A subjective sensation that correlates well with functional and physiologic parameters
- A subjective sensation that does not correlate well with functional and physiologic parameters (correct)
What is the relationship between dyspnea and tachypnea?
What is the relationship between dyspnea and tachypnea?
- Dyspnea and tachypnea are the same and can be used interchangeably
- Dyspnea is not the same as tachypnea; tachypnea refers to excessive rate of breathing (correct)
- Dyspnea and tachypnea are both physiologic parameters indicating breathing difficulty
- Tachypnea is a subjective sensation while dyspnea is a physiologic parameter
What is the first-line treatment for dyspnea control?
What is the first-line treatment for dyspnea control?
- Non-opioid medications
- Opioids (correct)
- Sedatives to induce sleep
- Antibiotics to treat underlying infections
What factors are correlated with higher reported prevalence of dyspnea?
What factors are correlated with higher reported prevalence of dyspnea?
What is the dual nature of dyspnea?
What is the dual nature of dyspnea?
Which type of dyspnea occurs as a result of an action or activity?
Which type of dyspnea occurs as a result of an action or activity?
What does the MRC Dyspnea Scale measure?
What does the MRC Dyspnea Scale measure?
What can accessory muscle use reflect in dyspnea?
What can accessory muscle use reflect in dyspnea?
What is considered the most important variable influencing the will to live among terminally ill cancer patients?
What is considered the most important variable influencing the will to live among terminally ill cancer patients?
Which breathing technique can help decrease dyspnea?
Which breathing technique can help decrease dyspnea?
What type of environment modification can help manage dyspnea?
What type of environment modification can help manage dyspnea?
'Social death' before physical death may occur due to what reason in patients with dyspnea?
'Social death' before physical death may occur due to what reason in patients with dyspnea?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?
'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?
What type of positioning can help avoid chest or diaphragm compression in dyspnea?
What type of positioning can help avoid chest or diaphragm compression in dyspnea?
What type of environment modification can trigger reflexes to decrease dyspnea?
What type of environment modification can trigger reflexes to decrease dyspnea?
Which of the following chronic diseases can also lead to Anorexia and Cachexia Syndrome (ACS)?
Which of the following chronic diseases can also lead to Anorexia and Cachexia Syndrome (ACS)?
Why does weight loss in ACS occur?
Why does weight loss in ACS occur?
What type of nutritional supplementation does not restore the lean body mass in ACS?
What type of nutritional supplementation does not restore the lean body mass in ACS?
How do families of patients with ACS often react towards nutritional intake?
How do families of patients with ACS often react towards nutritional intake?
What is an important aspect in the management of anorexia and cachexia syndrome?
What is an important aspect in the management of anorexia and cachexia syndrome?
What type of meals can be helpful for patients with anorexia and cachexia syndrome?
What type of meals can be helpful for patients with anorexia and cachexia syndrome?
How can creating a relaxing environment before meals benefit patients with anorexia and cachexia syndrome?
How can creating a relaxing environment before meals benefit patients with anorexia and cachexia syndrome?
What can healthcare professionals do to help manage dyspnea and anxiety in patients?
What can healthcare professionals do to help manage dyspnea and anxiety in patients?
What is the primary cause of anorexia and cachexia syndrome?
What is the primary cause of anorexia and cachexia syndrome?
Which statement is true about cachexia?
Which statement is true about cachexia?
What is the effect of opioids such as morphine and hydromorphone in advanced disease?
What is the effect of opioids such as morphine and hydromorphone in advanced disease?
Which therapy should not be the first line therapy for managing incident dyspnea?
Which therapy should not be the first line therapy for managing incident dyspnea?
What can contribute to weight loss in anorexia and cachexia syndrome?
What can contribute to weight loss in anorexia and cachexia syndrome?
What is the relationship between cachexia and starvation?
What is the relationship between cachexia and starvation?
What can assistive devices like walking aids help with?
What can assistive devices like walking aids help with?
Which artificial nutrition option is preferred for patients with good functional status and a prognosis of at least 2-3 months?
Which artificial nutrition option is preferred for patients with good functional status and a prognosis of at least 2-3 months?
What is the purpose of megestrol acetate in advanced cancer patients?
What is the purpose of megestrol acetate in advanced cancer patients?
Which pharmacological intervention can cause side effects such as adrenal suppression, hyperglycemia, and peptic ulcers?
Which pharmacological intervention can cause side effects such as adrenal suppression, hyperglycemia, and peptic ulcers?
What is the common complication in patients receiving chemotherapy or radiation therapy that affects the mouth and throat, leading to pain and difficulty swallowing?
What is the common complication in patients receiving chemotherapy or radiation therapy that affects the mouth and throat, leading to pain and difficulty swallowing?
What percentage of patients receiving standard dose chemotherapy will experience mouth and throat side effects?
What percentage of patients receiving standard dose chemotherapy will experience mouth and throat side effects?
Which feeding method is not supportive of comfort and does not improve longevity at the end of life?
Which feeding method is not supportive of comfort and does not improve longevity at the end of life?
Which artificial nutrition option is only recommended for patients with head and neck cancer or dysphagia?
Which artificial nutrition option is only recommended for patients with head and neck cancer or dysphagia?
What is the main purpose of corticosteroids in advanced cancer patients?
What is the main purpose of corticosteroids in advanced cancer patients?
What should be encouraged for patients at the end of life regarding their nutritional needs?
What should be encouraged for patients at the end of life regarding their nutritional needs?
What is the purpose of metoclopramide in cancer patients?
What is the purpose of metoclopramide in cancer patients?
What is a common complication associated with TPN (Total Parenteral Nutrition)?
What is a common complication associated with TPN (Total Parenteral Nutrition)?
What is the impact of oral complications on cancer patients?
What is the impact of oral complications on cancer patients?
What is dyspnea?
What is dyspnea?
What is the primary cause of dyspnea in advanced cancer patients?
What is the primary cause of dyspnea in advanced cancer patients?
What is the most common incidence of severe/very severe dyspnea in advanced cancer patients?
What is the most common incidence of severe/very severe dyspnea in advanced cancer patients?
Which medication is considered first-line for controlling dyspnea?
Which medication is considered first-line for controlling dyspnea?
What is the most important variable influencing the will to live among terminally ill cancer patients?
What is the most important variable influencing the will to live among terminally ill cancer patients?
What type of positioning can help avoid chest or diaphragm compression in dyspnea?
What type of positioning can help avoid chest or diaphragm compression in dyspnea?
What does the MRC Dyspnea Scale measure?
What does the MRC Dyspnea Scale measure?
Which breathing technique can help decrease dyspnea?
Which breathing technique can help decrease dyspnea?
What is the primary cause of anorexia and cachexia syndrome?
What is the primary cause of anorexia and cachexia syndrome?
'Social death' before physical death may occur due to what reason in patients with dyspnea?
'Social death' before physical death may occur due to what reason in patients with dyspnea?
'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?
'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
'Dual nature of dyspnea' refers to:
'Dual nature of dyspnea' refers to:
'Thorough physical assessment for advanced conditions like COPD is necessary to identify dyspnea causes and severity.' What does this statement emphasize?
'Thorough physical assessment for advanced conditions like COPD is necessary to identify dyspnea causes and severity.' What does this statement emphasize?
What is the effect of opioids such as morphine and hydromorphone in advanced disease?
What is the effect of opioids such as morphine and hydromorphone in advanced disease?
Which artificial nutrition option is preferred for patients with good functional status and a prognosis of at least 2-3 months?
Which artificial nutrition option is preferred for patients with good functional status and a prognosis of at least 2-3 months?
What is the effect of opioids such as morphine and hydromorphone in advanced disease?
What is the effect of opioids such as morphine and hydromorphone in advanced disease?
Which pharmacological intervention can cause side effects such as somnolence, confusion, and dysphoria, especially in the elderly?
Which pharmacological intervention can cause side effects such as somnolence, confusion, and dysphoria, especially in the elderly?
What type of environment modification can trigger reflexes to decrease dyspnea?
What type of environment modification can trigger reflexes to decrease dyspnea?
Which statement is true about cachexia?
Which statement is true about cachexia?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
What is an important aspect in the management of anorexia and cachexia syndrome?
What is an important aspect in the management of anorexia and cachexia syndrome?
'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?
'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?
What type of meals can be helpful for patients with anorexia and cachexia syndrome?
What type of meals can be helpful for patients with anorexia and cachexia syndrome?
What type of nutritional supplementation does not restore the lean body mass in ACS?
What type of nutritional supplementation does not restore the lean body mass in ACS?
What is the primary mechanism that leads to a catabolic state resulting in the breakdown of muscle and fat for energy in anorexia and cachexia syndrome?
What is the primary mechanism that leads to a catabolic state resulting in the breakdown of muscle and fat for energy in anorexia and cachexia syndrome?
Which of the following is NOT a secondary cause of anorexia and cachexia syndrome?
Which of the following is NOT a secondary cause of anorexia and cachexia syndrome?
In which disease populations is cachexia a significant predictor of decreased quality of life and shorter survival?
In which disease populations is cachexia a significant predictor of decreased quality of life and shorter survival?
What distinguishes cachexia from starvation?
What distinguishes cachexia from starvation?
What is the primary purpose of opioids such as morphine and hydromorphone in advanced disease?
What is the primary purpose of opioids such as morphine and hydromorphone in advanced disease?
Which therapy should not be the first-line therapy for managing incident dyspnea?
Which therapy should not be the first-line therapy for managing incident dyspnea?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
What can assistive devices like walking aids help with?
What can assistive devices like walking aids help with?
What is considered the most important variable influencing the will to live among terminally ill cancer patients?
What is considered the most important variable influencing the will to live among terminally ill cancer patients?
In patients with Anorexia and Cachexia Syndrome (ACS), weight loss cannot be fully explained by anorexia alone because the body gets energy by breaking down its own muscle and fat instead. What is the term for this catabolic state?
In patients with Anorexia and Cachexia Syndrome (ACS), weight loss cannot be fully explained by anorexia alone because the body gets energy by breaking down its own muscle and fat instead. What is the term for this catabolic state?
Which chronic diseases can also lead to Anorexia and Cachexia Syndrome (ACS), as mentioned in the text?
Which chronic diseases can also lead to Anorexia and Cachexia Syndrome (ACS), as mentioned in the text?
What is the term for the assessment of potential reversible causes of weight loss, such as mucositis, constipation, and gastroparesis, as mentioned in the text?
What is the term for the assessment of potential reversible causes of weight loss, such as mucositis, constipation, and gastroparesis, as mentioned in the text?
Which pharmacological intervention can cause side effects such as adrenal suppression, hyperglycemia, and peptic ulcers, as mentioned in the text?
Which pharmacological intervention can cause side effects such as adrenal suppression, hyperglycemia, and peptic ulcers, as mentioned in the text?
What type of meals can be helpful for patients with Anorexia and Cachexia Syndrome (ACS), according to the information provided?
What type of meals can be helpful for patients with Anorexia and Cachexia Syndrome (ACS), according to the information provided?
What is the term for creating a relaxing environment before meals to benefit patients with Anorexia and Cachexia Syndrome (ACS), as mentioned in the text?
What is the term for creating a relaxing environment before meals to benefit patients with Anorexia and Cachexia Syndrome (ACS), as mentioned in the text?
'Social death' before physical death may occur due to what reason in patients with dyspnea?
'Social death' before physical death may occur due to what reason in patients with dyspnea?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
'Palliative care drugs like opioids and benzodiazepines may be used' for what purpose in managing dyspnea?
'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?
'Oxygen should never be the only therapy in moderate-severe dyspnea and first-line medications should always be used.' What does this statement suggest about oxygen therapy?
'What is the primary cause of Anorexia and Cachexia Syndrome?' is a common misconception. What is the correct explanation for weight loss in ACS as mentioned in the text?
'What is the primary cause of Anorexia and Cachexia Syndrome?' is a common misconception. What is the correct explanation for weight loss in ACS as mentioned in the text?
What can healthcare professionals do to help manage dyspnea and anxiety in patients?
What can healthcare professionals do to help manage dyspnea and anxiety in patients?
Study Notes
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Team approach is used to manage independent feeding options for patients with advanced cancer and stomatitis (mouth sores and painful ulcers) caused by chemotherapy or radiation.
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Managing oral pain and considering artificial nutrition on an individual basis is essential.
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Artificial nutrition options include enteral and parenteral nutrition. Enteral nutrition is preferred for patients with good functional status and a prognosis of at least 2-3 months, while parenteral nutrition (TPN) is only recommended for patients with head and neck cancer or dysphagia.
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Enteral nutrition through tubes like NG, PEG, and jejunostomy, and parenteral nutrition through gastrostomy tubes or jejunostomy are considered only if there is a secondary condition requiring invasive nutritional interventions.
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There is no evidence to support that artificial nutrition prolongs life or functional status in advanced cancer patients.
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Pharmacological interventions for managing appetite and nutritional intake in advanced cancer patients include megestrol acetate, corticosteroids, metoclopramide, and cannabinoids.
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Megestrol acetate is a synthetic progesterone that acts on cytokines to inhibit TNF and increases appetite and overall weight gain, but does not reverse cachexia.
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Corticosteroids like dexamethasone and methylprednisolone increase appetite and nutritional intake are most effective with a life expectancy of less than 6-8 weeks, but they can cause side effects like adrenal suppression, hyperglycemia, and peptic ulcers.
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Metoclopramide is used to treat early satiety in gastroparesis and increases gastric emptying and decreases nausea, but it is not an appetite stimulant.
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Cannabinoids like nabilone and dronabinol increase appetite and decrease nausea but do not have evidence to recommend in advanced cancer. They can cause side effects like somnolence, confusion, and dysphoria, especially in the elderly.
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Mucositis or stomatitis is a common complication in patients receiving chemotherapy or radiation therapy, affecting the mouth and throat, leading to pain and difficulty swallowing.
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Oral complications like pain, taste alterations, difficulty chewing and swallowing, difficulty with speech and social isolation, and interrupted sleep can impact quality of life, contribute to functional decline, and failure to thrive.
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Stomatitis goes to the back of the throat, causing pain, difficulty swallowing, and sometimes bleeding.
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Approximately 40% of patients receiving standard dose chemotherapy and all patients receiving radiation therapy to the head and neck will experience mouth and throat side effects.
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Oral complications can lead to anorexia and cachexia, which can further impact quality of life and contribute to death.
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At the end of life, feeding is not supportive of comfort and does not improve longevity. Patients may not have the desire to eat, and if they do, small amounts of PO feeding by hand may be enough. Patients should be in an upright position and not receive TPN as it can increase morbidity and complications.
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TPN is not part of the WRHA palliative care program and requires monitoring, frequent blood work, and is expensive. It can cause complications like tube placement issues, skin excoriation, infection, blood clots, dumping syndrome, refeeding syndrome, and stimulate tumor growth.
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Pharmacological interventions should be used with caution, considering the patient's life expectancy and the potential side effects.
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At the end of life, comfort feeding may be sufficient to meet the patient's nutritional needs. Patients should be encouraged to eat if they desire, and if not, they should be supported with appropriate measures to ensure their dignity, respect, and comfort.
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Anorexia and Cachexia Syndrome (ACS) is a condition seen in advanced cancer patients where the body cannot process nutrients from food due to a catabolic state.
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Weight loss in ACS cannot be fully explained by anorexia alone, as the body gets energy by breaking down its own muscle and fat instead.
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Nutritional supplementation, such as Total Parenteral Nutrition (TPN), does not restore the lean body mass in ACS.
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ACS can also occur in other chronic diseases such as COPD, HIV, and advanced AIDS.
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Families of patients with ACS often put significant importance on nutritional intake and may exert pressure on the patient to eat more.
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Assessment for potential reversible causes of weight loss, such as mucositis, constipation, and gastroparesis, is important.
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Management of anorexia and cachexia syndrome involves education, supportive care, and addressing underlying causes.
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High protein, high calorie foods and small, frequent meals on the patient's schedule can be helpful.
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Trying various foods, textures, and seasonings, as well as providing nutrient dense liquids, can be beneficial.
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Creating a relaxing environment before meals and sitting upright after eating can promote digestion.
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Avoiding procedures and psychological distress prior to meals and limiting fluids before meals can also be helpful.
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Description
Test your knowledge on energy conservation techniques, the use of assistive devices such as walking aids and bathroom modifications, and the role of occupational therapy and physical therapy in managing dyspnea and anxiety in patients. This quiz covers topics related to relaxation therapy, breath control, and providing support and information to patients and their families.
