Podcast
Questions and Answers
What is a primary focus in the management of common conditions in palliative care?
What is a primary focus in the management of common conditions in palliative care?
Which symptom is NOT typically managed in palliative care?
Which symptom is NOT typically managed in palliative care?
What is a common misconception regarding nutritional needs in dying patients?
What is a common misconception regarding nutritional needs in dying patients?
Which of the following is a sign of the dying process?
Which of the following is a sign of the dying process?
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In end-of-life care, what should be considered regarding treatments?
In end-of-life care, what should be considered regarding treatments?
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What symptom may indicate the body is preparing for death in a patient?
What symptom may indicate the body is preparing for death in a patient?
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Which of the following is crucial for family members to understand when recognizing the dying process?
Which of the following is crucial for family members to understand when recognizing the dying process?
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Why should certain routine treatments be reconsidered for patients in palliative care?
Why should certain routine treatments be reconsidered for patients in palliative care?
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What is a common experience during the early stage of the dying process?
What is a common experience during the early stage of the dying process?
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Which symptom indicates a significant decline during the mid stage of the dying process?
Which symptom indicates a significant decline during the mid stage of the dying process?
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What might family members experience during the late stage of the dying process?
What might family members experience during the late stage of the dying process?
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In terms of hydration and feeding, what should be prioritized when communicating with families?
In terms of hydration and feeding, what should be prioritized when communicating with families?
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What describes a common physical sign in the late stage of dying?
What describes a common physical sign in the late stage of dying?
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What might be a consideration when addressing advanced directives for a patient like Arnold Kelley?
What might be a consideration when addressing advanced directives for a patient like Arnold Kelley?
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What environmental change may occur during the dying process regarding respiratory patterns?
What environmental change may occur during the dying process regarding respiratory patterns?
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What might indicate a need for an advanced directive in a patient who previously loved their family and didn’t want to be a burden?
What might indicate a need for an advanced directive in a patient who previously loved their family and didn’t want to be a burden?
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What was Arnold Kelley's initial condition that led to his hospital admission?
What was Arnold Kelley's initial condition that led to his hospital admission?
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What type of cancer was finally diagnosed in Arnold Kelley?
What type of cancer was finally diagnosed in Arnold Kelley?
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What was the patient’s family decision regarding his care at the end of life?
What was the patient’s family decision regarding his care at the end of life?
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Which medication was used for Arnold Kelley’s dyspnea and breathlessness?
Which medication was used for Arnold Kelley’s dyspnea and breathlessness?
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During his hospice care, what change was observed in Arnold Kelley's eating habits?
During his hospice care, what change was observed in Arnold Kelley's eating habits?
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What primary role did the physicians and nurses fulfill during Arnold Kelley's last day?
What primary role did the physicians and nurses fulfill during Arnold Kelley's last day?
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Which of the following medications is primarily used for treating terminal secretions?
Which of the following medications is primarily used for treating terminal secretions?
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In what way did Arnold Kelley's wife express her feelings towards his condition before he passed?
In what way did Arnold Kelley's wife express her feelings towards his condition before he passed?
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What was one effect of the concurrent use of steroids during Arnold's treatment?
What was one effect of the concurrent use of steroids during Arnold's treatment?
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What was reported about Arnold Kelley's ability to communicate towards the end of his life?
What was reported about Arnold Kelley's ability to communicate towards the end of his life?
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Study Notes
Management of Common Conditions
- Objective: Recommend and provide education on optimal management of common acute and chronic conditions in geriatric, palliative, and end-of-life care patients. This utilizes non-pharmacological methods, over-the-counter (OTC) medications, or prescription pharmacotherapy.
Common Concerns in Palliative Care
- Pain management
- Constipation management
- Symptoms related to breathing difficulties (dyspnea)
- Fatigue management
- Mood management
- Depression management
- Delirium management
- Loss of appetite and/or weight
- Dehydration management
- Nausea and vomiting management
- Terminal secretions management
Common Concerns in End-of-Life Care
- Covers all palliative care concerns listed above
- Additional concerns that come with the dying process
Dying Process
- Social withdrawal is common
- Reduced senses, particularly hearing, are common
- Increased sleep and restlessness are frequently observed
- Disorientation can occur, especially if stressed
- Reduced nutritional requirements
- Incontinence of urine and bowel is typically not a problem until near death.
- Methods for comfort like absorbent pads or catheterization may be used
- Changes in skin coloration (flushing, bluish hues, cold/clammy)
- Circulation changes, causing hands/feet to look purplish/blotchy
- Fluctuating blood pressure and pulse rate
- Variable temperature
- Irregular respirations or periods of apnea
- Congestion (rattling sounds in lungs/throat) from secretions is common. Patients may have reduced ability to clear secretions
Recognition of Dying Process
- Family and treatment goals should be discussed and confirmed.
- Stop treatments that do not contribute to comfort (pulse ox, IV hydration, antibiotics, finger sticks, etc.).
- Hydration and feeding issues need sensitive discussion.
- Excellent mouth and skin care should be provided.
Dying Process Time Course
- Early Stage: Bed bound, loss of interest in eating/drinking, cognitive changes, hypoactive or hyperactive delirium, increasing sleepiness.
- Mid Stage: Further mental decline (obtunded), "death rattle" (pooled secretions), loss of swallowing reflex, fever.
- Late Stage: Coma, cool extremities, altered respiratory patterns (fast or slow), fever, death.
Case Study: Arnold Kelley (82yo WM)
- Colon cancer (twice), chemotherapy (completed 4 years prior), good cognition.
- Personal history of Type 2 Diabetes Mellitus (T2DM) and stroke
- Family-oriented.
- Concerns regarding inevitable decline in health.
- Artificial feeding question.
- Chest compressions question.
- Family needs for information
- Appropriate advanced directives.
Case Study: Arnold Kelley (83yo WM)
- Diagnosed with a brain tumor after hospital admission.
- Left-side lower extremity weakness and difficulty walking.
- Offered oral chemotherapy and radiation.
- Some improvement with steroids, but re-hospitalization required.
- Developed opportunistic pneumonia and oxygen support needed.
- Repeat MRI confirmed glioblastoma (tumor crossing the midline).
- No additional curative options exist.
- Decreasing functionality and declining breathing.
- Questions: duration of hospital stay, best nutritional support, location in the palliative care continuum, hospice appropriateness.
- Family preference for home vs. hospice
- Reporting that he feels he has lived a good life and will see Jesus soon.
Case Study: Arnold Kelley (83yo WM) - Hospice Care
- Receiving soft nutrition as tolerated.
- Decreasing desire to eat and ability to eat.
- Spouse/wife needs emotional support through this decline.
- Reduced ability to carry on conversations.
- Increased sleeping and breathing difficulties.
- Oral liquid opioids for comfort.
- Family reunites and says goodbyes.
- Passes peacefully with family at the bedside.
Medications
- Provides a list of relevant medications, dosage, and frequency.
- Chlorpromazine, Lorazepam, Roxanol (morphine sulfate), Haloperidol, Megestrol, Scopolamine, Atropine, Hyoscyamine.
Additional Information
- Patient's obituary link.
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Description
This quiz focuses on the management of common conditions in geriatric, palliative, and end-of-life care. It covers pain, mood, appetite, and other concerns that arise during these critical stages. Assess your knowledge on non-pharmacological methods and pharmacotherapy used in these settings.
