Assessment
This 0-to-10 scale is commonly used to measure pain intensity.
What is the Numeric Rating Scale?
Hidden clocks, lack of hearing aids, sleep disruption, and an unfamiliar hospital room are examples of these types of delirium risk factors.
What are physical/environmental risk factors?
Burning, shooting, tingling and electric-like sensations are characteristic of this type of pain.
What is neuropathic pain?
This position can reduce the work of breathing in a patient experiencing significant dyspnea.
What is tripod positioning?
Providing a visible clock and calendar helps with this important delirium prevention strategy.
What is orientation?
This screening tool requires the presence of an acute onset and fluctuating course, inattention, and either disorganized thinking or altered level of consciousness.
What is the Confusion Assessment Method (CAM)?
This common cancer complication can compress the lung and cause significant breathlessness.
What is a pleural effusion?
This type of pain occurs episodically despite controlled baseline pain and may be triggered by movement.
What is breakthrough pain?
When a family member says, "He was fine this morning, but then a few hours later he's confused," they are describing this key feature of delirium.
What is acute onset?
Patients taking opioids should routinely receive this supportive intervention to prevent a common GI side effect.
What is bowel regimen?
For a patient reporting pain, dyspnea, or nausea, this is usually the most important source of information about symptom severity.
What is the patient's self-report?
This previous cancer treatment may contribute to persistent burning, tingling, or shooting pain.
What is neurotoxic chemotherapy?
This subtype of delirium is often mistaken for depression or fatigue because patients appear withdrawn, quiet, and sleepy.
What is hypoactive delirium?
This medication class is commonly used to relieve moderate-to-severe cancer-related dyspnea.
What are opioids?
Relaxation and breathing exercises are examples of these non-drug approaches to pain management.
What are non-pharmacological interventions?
A patient who is alert and restless, then hours later is quiet and lethargic.
What is mixed subtype delirium?
This patient with cancer is at greatest risk for delirium: a 52-year-old with lung cancer, COPD and substance abuse or a 72-year-old with previously treated lung cancer in survivorship, pacemaker, HTN, and low dose opioids for chronic pain.
Who is the 52-year-old?
Poorly localized, cramping cancer pain caused by tumour involvement of internal organs represents this type of pain.
What is visceral pain?
This medication may be added to opioid therapy to help manage neuropathic cancer pain.
What is gabapentin? (pregabalin is also acceptable)
This breathing strategy encourages a gentle breath in followed by a slower, longer exhalation.
What is controlled or pursed-lip breathing?
A patient with metastatic lung cancer develops sudden severe dyspnea that is significantly worse than yesterday. Before assuming disease progression, the nurse should assess for this.
What is a new or reversible cause of dyspnea?
A patient with cancer develops sudden unexplained dyspnea, tachycardia and pleuritic chest pain. This potentially life-threatening cause must be considered.
What is a pulmonary embolism?
A patient is sitting forward, leaning on the bedside table, using accessory muscles and speaking only in short phrases. These findings suggest this.
What is significant respiratory distress/severe dyspnea?
A patient with advanced cancer has severe dyspnea despite treatment of the underlying cause. Name three non-pharmacological interventions that can be initiated immediately.
What are upright positioning, cool airflow/fan, and calm breathing, coaching, reassurance?
A patient with advanced cancer has persistent dyspnea despite treatment of reversible causes and appropriate symptom management. She says, “I don't want to keep coming to the hospital. I just want to be comfortable at home.” This should guide the next conversation.
What are her goals of care and what matters most to her?