The Final Countdown
The majority of patients undergoing palliative extubation die within this time frame
What is hours to 1 day
This side effect of opioid therapy never abates
What is constipation?
This condition classically includes Beck's Triad of hypotension, elevated jugular venous pressure, and distant, muffled heart sounds accompanied by tachycardia and pulsus paradoxus
What is cardiac tamponade?
This anti-cholinergic medication used for secretions does not cross the blood-brain barrier
What is glycopyrrolate?
This term encompasses decision-making: citing that patients must be able to express insight, make a rational choice, demonstrate that they are not delusional, and express consistent preferences
What is capacity?
The majority of patients with end stage renal disease that stop hemodialysis will die within this time frame
What is 7-14 days?
This opioid is safe in patients with renal dysfunction (name one)
What are (fentanyl, methadone, buprenorphine)?
In addition to oral pain management, this procedure can be offered to patients with spinal compression fractures
What is vertebroplasty (or kyphoplasty)?
The most effective nonpharmacologic intervention for dyspnea at the end of life
What is fan therapy?
This term is used to describe a circumstance that no evidence shows that a specific treatment desired by the patient will provide any medical benefit, and the clinician is not ethically obliged to provide such treatment
What is futility?
The average prognosis for patients with malignancy-related hypercalcemia (range)
What is weeks to months (more specifically, trials have shown median OS to be around 40 days)
This long acting opioid can be administered via PEG tube
What is methadone (tablets can be crushed and oral elixir)? (of note, morphine ER capsules/pellets can actually be opened and given via PEG tube, but methadone comes in oral elixir)
You are called to see a new patient in your inpatient palliative unit who has new onset cough and hoarseness. Upon arrival to the room, you note the patient has upper extremity and facial edema. You have concern for SVC syndrome. You tell nursing to implement these nonpharmacologic interventions.
What are elevating the patients head and avoiding venipunctures/IV access in the upper extremities?
This nonpharmacologic therapy is associated with significant reductions in cancer related fatigue
What is aerobic exercise
This principle validates the use of treatments intended to relieve suffering or restore health even if the intervention has potential untoward effects such as shortening a patient's life
What is the principle of double effect?
The average prognosis for patients with malignant inoperable bowel obstruction (range)
What is weeks to months? (more specifically, ranges are typically 2 weeks to 6 months)
This iatrogenic syndrome presents as behaviors that mimic addiction but are really driven by unrelieved pain
What is pseudoaddiction?
This medication is first line for isolated seizure activity, but not recommended alone for status epilepticus
What is lorazepam?
Artificial nutrition via PEG tube has been proven beneficial for this disease state
What is ALS
OR head and neck/esophageal cancer
Continuous home care includes a minimum of ______ hours of nursing, hospice aide, or homemaker services, with at least 50% of those hours provided by RN/LPN/LVN
What is 8 hours?
Mrs. X is a 57 yo F PMH ALS who presents to your palliative medicine clinic for a follow up visit. She tells you that she has been researching ways to speed up the dying process, and is thinking about voluntarily stopping eating and drinking (VSED). You discuss the trajectory for VSED and what she can expect if this is within her wishes. She asks you what her prognosis will be if she decides this is the best option for her.
What is 1 to 3 weeks?
oxaliplatin, carboplatin, cisplatin, paclitaxel, docetaxel, bortezomib, lenalidomide, thalidomide, and vinca alkaloids
Your patient arrives to your palliative care clinic with central back pain in L3-L5 distribution aggravated by sneezing. While reviewing their history, they also admit to new onset fecal incontinence. You have concern for spinal cord compression and decide to order this imaging study next (be specific)
MRI of the entire spine (about 1/3 of cord compressions have multiple metastatic sites that can change the treatment course)
Ondansetron inhibits this neurotransmitter from stimulating the chemoreceptor trigger zone and vomiting center
What is serotonin
What is the case of Baby K?