Palliative Care and Pain Management Quiz

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Questions and Answers

Which barrier to palliative care refers to a lack of understanding about its purpose and benefits?

Restrictive eligibility criteria

Misunderstanding (correct)

Reluctance

Provider bias

What is one reason why an oral route is generally preferred for pain management?

It provides quicker pain relief

It eliminates the risk of gastrointestinal issues

It is less effective than other routes

It is more convenient for most patients (correct)

Which of the following is NOT a common side effect of opioids?

Respiratory Depression

Sedation

Hallucinations (correct)

Constipation

What does the principle of avoiding delay in treatment aim to achieve in pain management?

To minimize the development of chronic pain Signup and view all the answers

Which component is part of a full history in palliative assessment?

Psychological and social well-being Signup and view all the answers

What characterizes severe radiculopathy?

Sensory loss and pain with marked motor deficits Signup and view all the answers

Which treatment is primarily surgical?

Discectomy Signup and view all the answers

What is a key priority in the management of radiculopathy?

Monitor for complications Signup and view all the answers

Which of the following is NOT a common treatment option for radiculopathy?

Acupuncture Signup and view all the answers

What type of radiculopathy is indicated by sensory loss and pain with mild motor deficits?

Moderate radiculopathy Signup and view all the answers

What is the primary benefit of superficial heating/cooling in pain management?

Provides effective relief for localized pain Signup and view all the answers

Which statement best describes the role of acupuncture in pain management?

Releases endogenous opioid peptides Signup and view all the answers

What is a significant consideration when treating older adults with pain management medications?

They metabolize drugs more slowly, increasing risk of side effects Signup and view all the answers

What is the purpose of pacing in pain management?

To manage anxiety and conserve energy through scheduled breaks Signup and view all the answers

What challenge might arise when treating clients with both pain and substance abuse problems?

Assessing pain relief while minimizing withdrawal symptoms is complex Signup and view all the answers

What is the typical protein level in CSF during the initial phase of GBS?

Normal or low protein content Signup and view all the answers

Which treatment is recommended for GBS within the first two weeks of onset?

IVIG Signup and view all the answers

What is a common symptom that needs monitoring in GBS patients?

Fever Signup and view all the answers

What type of support is commonly needed for GBS patients regarding their reflexes?

Reflexes are usually absent or decreased Signup and view all the answers

What is a significant aspect of care to consider for GBS patients to prevent complications?

Prevention of DVT and PE is important Signup and view all the answers

Which symptom is primarily associated with motor neuropathy?

Tremors Signup and view all the answers

What is a common condition that can lead to nerve damage?

Guillain-Barre syndrome Signup and view all the answers

Which of the following is NOT a complication of peripheral neuropathy?

Increased energy levels Signup and view all the answers

Which phase is characterized by the return of neurological function in Guillain-Barre Syndrome?

Recovery phase Signup and view all the answers

What is the initial location of weakness in Guillain-Barre Syndrome?

Feet Signup and view all the answers

Which type of neuropathy is associated with problems in temperature regulation?

Autonomic neuropathy Signup and view all the answers

Which of the following best describes the pathophysiology of Guillain-Barre Syndrome?

Demyelination and inflammation Signup and view all the answers

Which medication type is commonly associated with causing nerve damage?

Antibiotics Signup and view all the answers

What is the primary goal of palliative care?

To provide relief from pain and distressing symptoms Signup and view all the answers

When is a palliative approach typically utilized?

For progressive or incurable diseases Signup and view all the answers

Which of the following is NOT a symptom leading to the need for palliative pain management?

Minor muscle strain Signup and view all the answers

What is a critical action to take if Cauda Equina Syndrome is suspected?

Schedule an MRI immediately Signup and view all the answers

Which of the following describes saddle anesthesia?

Numbness in the area around the L4/5 region Signup and view all the answers

What effect does culture have in palliative care?

It may influence patient preferences and decision making Signup and view all the answers

What is a key aspect of correct posture when standing?

Feet shoulder-width apart with weight evenly distributed Signup and view all the answers

Which of the following describes the correct technique for lifting heavy objects?

Lifting with legs while keeping the load close to the body Signup and view all the answers

Study Notes

Pain & Sensory Perception

Pain is whatever the experiencing person says it is, Existing whenever they say it does (International Pain Society, 2018).
Pain is shaped by many different factors.
It's vital to listen to a patient's description of pain and how it affects their life.
Consider psychological distress as a potential factor in ineffective pain management and over-reliance on medication.
Assess the patient as a whole.

Main Types of Pain

Nociceptive Somatic: Pain related to skin nociceptive activity, localized pain (sharp, aching, throbbing).
Nociceptive Visceral: Pain related to organs/body cavities, gnawing, cramping, dull pain.
Neuropathic: Pain resulting from nerve damage, burning, prickling, tingling, numbness.

Pain Pathways

Pain starts in one or more body parts.
Pain signals travel through nerves to the spinal cord.
The brain interprets the signals as pain.
Endorphins released by the brain may reduce pain perception.

Pain Assessment

Onset: When did the pain start?
Provocative/Palliative: Does pain increase with movement? Are symptoms relieved with rest?
Quality: Describe the pain (e.g., sharp, dull, throbbing).
Region: Where is the pain located?
Severity: Rate the pain on a scale (e.g., 0-10).
Treatment/Timing: What treatments have worked in the past? Is the pain dull, constant, or intermittent?
Understanding: Patient history and past experiences
Values: Acceptable levels of pain, patient goals of care

Nonverbal Signs of Pain

Facial expressions (grimacing, furrowed brows, pursed lips)
Clenched jaw/teeth
Grasping blankets
Rigid body
Unusual breathing patterns
Agitation/irritability
Moaning/calling out
Not responding to voice
Flinching to touch
Guarding painful areas
Kicking or restless legs
Rocking

Fibromyalgia

Fibromyalgia (FM) is a chronic condition characterized by widespread, non-articular musculoskeletal pain and fatigue.
Patients often experience nonrestorative sleep, morning stiffness, irritable bowel syndrome, anxiety, and more.

Fibromyalgia Diagnosing

Women are nine times more likely to be diagnosed than men.
Age range: 30-50 years old
Past medical history (rheumatic conditions, chronic fatigue, Lyme disease, trauma, deep sleep deprivation).
Family history of fibromyalgia.

Fibromyalgia - Understanding

There isn't a full understanding of how fibromyalgia works yet.
It is believed to involve central processing problems of nociceptive pain input.
Patients often report a lower pain threshold.
Neuroimaging studies show possible neurotransmitter level imbalances affecting sensory transmission.
There appear to be potential physiological abnormalities, such as increased Substance P in the spinal cord, and lower levels of blood flow to the thalamus and lower levels of serotonin.

Most Common Signs of Fibromyalgia

Widespread pain: worsens and improves throughout the day
Difficulty determining the pain's origin (muscle, joint, or soft tissue)
Head/face pain, often stiffness/pain in neck and shoulder muscles, and TMJ dysfunction (in about 1/3 of cases).
Point tenderness at specific sites across the body.

Additional Fibromyalgia Symptoms

Fatigue, sleep issues, cognitive issues, memory problems, headaches, dizziness, pain in muscles and joints, and skin problems, with urinary issues (Dysmenorrhea) and restless leg syndrome also being common.

When Is It Fibromyalgia?

Widespread pain, lasting at least three months
Tender points (previously considered necessary, though now less emphasized)
Ruling out other possible causes for the pain.

Nerve Root Compression

Normal Disc: A healthy spinal disc has a nucleus pulposus enclosed by an annulus fibrosus..
Degenerative Changes: When the disc loses hydration, it becomes degenerated. Bulging, and herniated discs occur as the nucleus pusposus bulges or herniates through the annulus.
Symptoms: Nerve root compression results in radiculopathy. Symptoms can include pain, numbness, and weakness.
Risk Factors: Older age (30-50), male, family history, obesity, spine overuse

Radiculopathy Symptoms

Pain (type and location dependent on the injured area)
Numbness (especially along the skin area near the affected nerve)
Weakness (loss of sensation, impaired reflexes, changes in soft tissues)

Radiculopathy Diagnosing

Physical exam (muscle strength, reflexes, pain in response to movement).
Imaging (X-ray, CT, MRI)
Nerve conduction studies to pinpoint nerve dysfunction.

Radiculopathy Treatment

Pharmacology (NSAIDs, opioids, muscle relaxants, corticosteroid injections).
Heat therapy to decrease spasms and inflammation
Massage therapy
Ultrasound therapy
TENS (Transcutaneous Electrical Nerve Stimulation)
Physiotherapy (to limit extreme movement, brace, corset, belt, building muscles)
Possible surgical treatments (laminectomy or discectomy).

Cauda Equina Syndrome

A medical emergency.
Damage to the cauda equina, the nerve roots below the spinal cord.
Symptoms include bladder and bowel dysfunction, sexual dysfunction, saddle anesthesia, limb impairment, and weakness.
Crucial to get an MRI immediately (within 48 hours) and surgical decompression if indicated to prevent permanent damage.

Palliative Pain Management

Palliative care: aims to improve quality of life for those with life-threatening illnesses, and often works in conjunction with other treatments
Palliative care is not meant to hasten or postpone death; it's about providing relief from pain/distress and support to live as actively as possible.
Important goals include pain control, preventing prolonged suffering, achieving control, easing family burden, clear decision-making, and completing life tasks if possible..
Phases and layers: involve symptom management, maximizing quality of life, end-of-life, and terminal care (including physical, psychological, social and spiritual support).

Palliative Pain Management - Potential Causes of Pain

Disease related: Nerve alterations/invasions, pressure on organs/tissues.
Indirect factors: Constipation or other issues caused by disease.
Treatment related: Side effects from radiation, chemotherapy, surgery.

Barriers to Palliative Care

Lack of resources, knowledge
Misunderstanding
Provider bias
Reluctance
Restrictive eligibility criteria

Palliative Assessment

Full Patient History (absolutely crucial)
Complete Examination (physical, psychological, social, spiritual)
Investigations based on the reason for palliative involvement, if necessary.

Basic Principles of Pain Management

Avoid Delay in treatment
Utilize the "pain ladder"
Oral medications preferred wherever possible
Consistent pain management plan
Manage breakthrough pain, as needed.
Education is necessary so patients feel empowered to understand how to manage their pain.

WHO Pain Ladder

A step-by-step approach for managing pain using different types of medications, depending on the severity.

Common Opioid Side Effects (Possible Complications)

Respiratory depression
Constipation
Nausea
Sedation
Itching (pruritus)
Urinary retention

Non-pharmacological Interventions

Relaxation techniques. Includes relaxation, superficial heating/cooling (e.g., warmth, ice packs), and acupuncture.
Reflection
Activity pacing

Treatment cautions, such as slower drug metabolism, increased risk of adverse effects from medications, and increased risk of GI bleeding if treating with NSAIDs.

Special Populations (clients with substance abuse issues)

The right to effective pain management.
Need a dual approach to manage pain and substance abuse issues.
A multidisciplinary team approach is frequently needed.

Peripheral Neuropathy

Mononeuropathy (one nerve), Polyneuropathy (multiple nerves).
Symptoms vary based on which nerves are damaged.
Can include motor, sensory, and autonomic problems.

Known Conditions that Cause Nerve Damage

Autoimmune conditions (e.g., Guillain-Barré syndrome, SLE, Rheumatoid Arthritis)
Diabetes
Infections (e.g., Lyme disease, herpes, shingles, syphilis, HIV)
Other medical conditions (e.g., kidney/liver disorders, metabolic disorders, vascular issues, tumors)
Medications (e.g., antibiotics, chemotherapy, radiation)
Injuries/surgery, Falls, car accidents (temporary or permanent damage)
Vitamin deficiencies.

Complications of Peripheral Neuropathy

Burns/skin injuries
Falls
Infections
Heart and circulatory system problems
Diabetic foot ulcers
Gangrene

Guillain-Barré Syndrome (GBS)

An acute, rapidly progressive, and potentially fatal inflammatory condition.
Affects the peripheral nervous system.
Results in loss of myelin (segmental demyelination).
Manifests as a symmetrical ascending paralysis.

GBS Pathophysiology

Demyelination occurrence
Reduced/stopped transmission of nerve impulses
Muscle denervation/atrophy
Proximal-to-distal recovery.

GBS Clinical Manifestations

Symmetrical muscle weakness (ascending pattern)
Loss of deep tendon reflexes
Paresthesias (first in the feet)
Autonomic dysfunction (e.g., blood pressure fluctuations, GI stasis)
Respiratory problems (as disease progresses)
Neuropathic pain.

GBS Diagnosing

History and physical exam.
CSF analysis (often normal or with low protein initially, elevated protein subsequently)
Electromyography (EMG)
Nerve conduction studies.

GBS Assessment & Management

Supportive care
Constant monitoring of the respiratory system (acute phase management in a critical care unit)
Assess for fever and treat ASAP
Prevention of DVT and PE (prophylactic anticoagulation)
Assess gag, corneal, and swallowing reflexes
Assess blood pressure (orthostatic hypotension is common)

GBS Treatments

Intravenous immunoglobulin (IVIG)
Plasmapheresis

GBS - Further Considerations

Emotional support for patient and family.
Frequent assessment of skin and wounds.
Assessment for and management of urinary retention.
Passive range of motion exercises
Eye care to prevent corneal damage.
Nutritional support (NG tube or TPN as necessary)

Trigeminal Neuralgia (TN)

A condition characterized by intense, sudden, electric-shock-like pain in the face.
Usually one side of the face
It's an uncommon cranial nerve disorder.

TN Clinical Manifestations

Intense electrical or stabbing pain in the face.
Commonly the jaw, lips, gums, cheek, forehead, or side of nose
Brief attacks (seconds to minutes)
Unpredictable, but can cluster

TN Diagnosing

Complete neurologic exam
MRI to rule out other conditions, especially stroke
EMG (electromyography: checks nerve and muscle function)

TN Management

Pharmacological: Carbamazepine (first line), Baclofen.
Conservative: Biofeedback strategies
Surgical: Glycerol rhizotomy, Percutaneous radiofrequency rhizotomy, Microvascular decompression.

Bell's Palsy

Facial nerve disorder (cranial nerve VII).
One-sided facial muscle weakness.
Often sudden onset.
Usually recovers in 3 weeks.

Bell's Palsy Clinical Manifestations

Unilateral facial paralysis (one side of the face is affected).
Inability to frown, smile, close eyelid.
Decreased muscle movement.
Facial drooping.
Loss of taste.
Distorted taste.
Abnormal tearing
Pain (neck, mastoid, or ear).

Bell's Palsy Diagnosis

Based on the clinical presentation, physical and neurological exams.
Rule out other conditions like strokes with CT/MRI imaging.

Bell's Palsy Management

Eyes: Protection, lubrication, tape for eyelid closure
Oral: Soft diet
Heat: Hot, moist heat therapy to support the affected area
Medications: Analgesics, corticosteroids to reduce inflammation, antivirals possibly.
PT/OT: Physical or occupational therapy, facial sling, other support measures as necessary.

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Description

Test your knowledge on palliative care barriers, pain management techniques, and assessment components. This quiz covers various aspects including opioid side effects, treatment priorities, and the role of acupuncture. Perfect for those studying palliative care and pain management practices.