Hospice And Palliative Care

Front 1

All cancers metastasize to the lymph nodes except 1________, 2________

Back 1

Brain, Uterus

Front 2

Uterine cancer metastasis sites
1_________, 2__________

Back 2

Bone, Peritoneum

Front 3

Each of these 6 kinds of cancer have at least 6 sites of metastasis.,

Back 3

Breast, Cervix, Leukemia, Lymphoma, Lung, Melanoma

Front 4

Breast cancer metastasis sites

Back 4

Bone, bone marrow, lung, liver, nodes, brain

Front 5

Brain cancer metastasis sites

Back 5

Only to brain

Front 6

Prostate cancer metastasis sites 5of them

Back 6

Bone, bone marrow, lung, liver, nodes

Front 7

Melanoma metastasis sites 7 of them

Back 7

Bone, bone marrow, skin, lung, liver, nodes, brain

Front 8

Leukemia/lymphoma metastasis sites 6 of them

Back 8

Bone, bone marrow, skin, lung, nodes, brain

Front 9

Cancers that spread to the brain 5 of them

Back 9

Breast, kidney, leukemia/lymphoma lung, melanoma

Front 10

Cancers that spread to the bone
11 of them

Back 10

Breast, cervix, esophagus, liver, kidney, lung, melanoma, prostate, stomach, testes, thyroid

Front 11

Cancers that spread to the liver 13 of them

Back 11

Breast, cervix colon, esophagus, kidney, lung, melanoma, ovary, pancreas, prostate, sarcoma, stomach, testes

Front 12

Signs and symptoms of advanced cancer

Back 12

Weakness, anorexia, cachexia, pain, nausea, constipation/diarrhea, dyspnea, edema, change in LOC, confusion, agitation, infections

Front 13

Cancers that are most likely to be fatal 6 of them

Back 13

Esophagus, Lung, Liver, Pancreas, Ovarian, Multiple myeloma

Front 14

Angiogenesis

Back 14

Generation of blood vessels around the primary tumor that increases chance for tumor cells to reach blood stream and colonize

Front 15

Oncologic emergencies and complications

Back 15

Spinal cord compression,
Intracerebral metastases,
Syndrome of inappropriate antidiuretic hormone (SIADH),
Hypercalcemia,
Hemorrhage,
cardiac tamponade,
superior vena cava syndrome,
DIC,
Bowel obstruction,
Septic shock,
Tumor lysis syndrome,
Anaphylaxix

Front 16

spinal cord compression symptoms

Back 16

localized back pain, motor deficits, sensory deficits paresthesia, bowel and bladder inc, bladder retention

Front 17

Spinal cord compression treatments

Back 17

Steroids high doses, Radiation, stabilization surgery,
Needs emergency treatment to prevent permanent damage. If pt is candidate for tx.

Front 18

Intracerebral metastases signs and symptoms

Back 18

causes increased ICP, early morning headache, confusion, agitation, projectile vomiting, cognitive dysfunction

Front 19

Syndrome of inappropriate antidiuretic hormone symptoms:

Back 19

weight gain, Hyponatremia
nausea, vomiting, altered mood, weak, lethargic, confused, muscle cramps, loss of consciousness.

Front 20

Syndrome of inappropriate antidiuretic hormone treatment:

Back 20

Fluid restriction, furosemide, hypertonic saline, Demeclocycline

Front 21

Hypercalcemia signs & symptoms

Back 21

Calcium greater than 11 mg/dl nausea, vomiting, anorexia, constipation, lethargy, confusion, polyuria, stupor, coma, mental status changes, polydipsia

Front 22

Hypercalcemia treatments

Back 22

Hydratrioon, Furosemide, if has fluid retention, steroids

Front 23

Hemmorhage signs and symptoms

Back 23

Tumor erosion or invasion near major blood vessel, oozing or bleeding, anxiety, decreased blood pressure, respiratory distress

Front 24

Hemmorhage treatment

Back 24

Prepare and support family, dark towels and sheets, pain medication, treat oozing with topical epinephrine

Front 25

Cardiac Tamponade Signs and symptoms

Back 25

muffled heart sounds, pericardial rub, tachycardia, pulsus paridoxux, dyspnea, cough, dysphagia, retrosternal chest pain, hoarseness, increased jugular venous pressure

Front 26

Cardiac Tamponade Treatment

Back 26

Anxiolytics, Oxygen, pericardiocentesis, radiation

Front 27

Causes of
Superior Vena Cava Syndrome

Back 27

Cancer of lung, breast, lymphoma, brain tumors, blood clots in SVC, Infections, TB,Edema, STD, sarcoidosis

Front 28

Superior vena cava syndrome
signs and symptoms

Back 28

edema of face, trunk, and upper extremities; distended veins in neck, headache, chest pain, visual and mental changes, dizziness, dry cough

Front 29

Superior vena cava syndrome
Treatments

Back 29

Depend on the cause of SVCS Steroids, Furosemide, radiation, chemo, warfarin, elevate HOB

Front 30

DIC disseminated intravascular coagulation signs and symptoms

Back 30

bleeding, clotting, dyspnea, restlessness, tachycardia, petechiae, purpura, altered LOC

Front 31

DIC disseminated intravascular coagulation Treatments

Back 31

Hydration, Oxygen, anxiolytics (lorazepam), heparin, antithrombin II treat malignacy, blood component therapy

Front 32

Large bowel obstruction
signs and symptoms

Back 32

Crampy pain lower abdomen that increases over time. Vomiting a late sign, constipation, abdominal distention, abnormal bowel sounds

Front 33

Large bowel obstruction
Treatments

Back 33

Pain control, anti nausea, anxiolytics, glycopyrrolate, Octreotide, stent, IV therapy, surgery

Front 34

Small bowel obstruction
signs and symptoms

Back 34

Crampy colicky pain in mid to upper abdomen relieved by vomiting

Front 35

Small bowel obstruction
Treatments

Back 35

Pain control, anti nausea, anxiolytics, NG suction, stent, IV therapy, surgery

Front 36

bowel strangulation
signs and symptoms

Back 36

severe steady abdominal pain

Front 37

bowel strangulation Treatments

Back 37

surgery, antibiotics NG tube

Front 38

Palliative surgery

Back 38

bone stabilization, relieve bowel obstruction, place stents, pain management, tumor debulking,
Relief of symptoms without a goal of curing the disease

Front 39

Palliative radiation therapy

Back 39

relieves symptoms including pain, bleeding, compression of vital organ systems, ulcerating skin lesions, skeletal and brain mets, spinal cord compression, SVCS,

Front 40

ILEUS what is it and signs/symptoms

Back 40

It is paralyzed intestines,
Moderate diffuse abdominal pain constipation, abdominal distension, No BM, NO Gas, Nausea, vomiting, belching

Front 41

ILEUS treatment

Back 41

NPO, lactulose, electrolytes

can be caused by opiods, peritonitis, spinal cord injury

Front 42

Constipation caused by what medications

Back 42

Opiods, tricyclic antidepressants, phenothiazines, antacids, diuretics, iron, vincristine, anti-hypertensives, anticonvulsants, anticolinergices, NSAIDs ***Discontinue any of these meds that are not needed.

Front 43

Constipation caused by what diseases and disorders

Back 43

Obstruction, abdominal tumors , Colitis, diverticular disease, diabetes, hypercalcemia, hypokalemia, hypothyroidism

Front 44

Constipation caused by what life-style choices and neurological changes

Back 44

Low fiber intake, insufficient fluid intake, inactivity, immobility, confusion, depression, sedation

Front 45

Other causes of constipaiton

Back 45

Pain from hemorrhoids and other rectal pain, embarrassment, loss of independence.

Front 46

Digital disimpation contraindicated in

Back 46

Lower GI bleed, thrombocytopenic patients, neutorpenic patients, end stage cardiac

Front 47

Constipation signs and symptoms

Back 47

Distension, tenderness, bloated, bowel sounds normal of hypo-active; percussion reveals unusual dullness, may be able to palpate stool in bowel

Front 48

Medication used for severe opioid related constipation

Back 48

Methylnaltrexone (Relistor) works in less than an hour, reverses the effect of opioid only on the bowel not pain control

Front 49

Titrate laxatives

Back 49

When changing opioid dosing, should be scheduled not PRN
SennaS has both softener and stimulant.

Front 50

If no bowel movement in 3 days

Back 50

increase fluids order osmotic laxative
Osmotic Laxatives include
MOM
Lactulose (use this if liver is involved)
Sorbitol
Miralax

Front 51

Bowel obstruction or impaction can surprisingly cause

Back 51

Diarrhea

Front 52

Stage I Decubitus

Back 52

Reddened intact skin, does not blanch when pressure applied, may be painful, may be warmer, cooler, and or a different texture from other skin. Dark skinned people it will not appear reddened it will appear darker

Front 53

Stage II Decubitus

Back 53

Partial thickness skin loss, shallow looks like a blister, abrasion

Front 54

Stage III Decubitus

Back 54

Full thickness skin loss with or without damage to subcutaneous tissue or undermining

Front 55

Stage IV Decubitus

Back 55

Full thickness skin loss deep damage extends to muscle, tendons even to bone. often has tunneling

Front 56

Evaluate pressure areas for

Back 56

Size, depth, color, tissue type, odor, exudate (quantity and color)

Front 57

Xerostomia treatments

Dry Mouth

Back 57

Change medications (if on meds that dry the mucous membranes);
Stimulate salivation, peppermint water, sugar free hard candy, ice chips, gum, no lemon or vitamin C;
Treat dehydration, increase fluids, toothettes, ice chips
Artificial saliva

Front 58

Xerostomia causes

Dry mouth

Back 58

Dehydration caused by poor intake of fluids or other disease process such as:Hypercalcemia, hyperglycemia ,
mouth breathing,
Medications and treatments: Anticholinergics, antihistamines, phenothiazines, radiation, chemotherapy,
,

Front 59

Nociceptic Pain

Back 59

Somatic or visceral pain, Pain that is not neuropathic

Front 60

Neuropathic Pain
Symptoms

Back 60

Shooting, burning
may also have tingling and numbness

Front 61

Somatic Pain

Back 61

Well localized pain described as deep dull ache, Musculoskeletal in nature controlled with NSAIDS if mild, opiates if severe

Front 62

Visceral Pain

Back 62

Pain that is poorly localized cramping, often referred to distant dermatomal site. Controlled with analgesics antispasmodics, antineoplastics, examples: bowel obstruction, lung tumors, cholesystitis, angina

Front 63

Dysthesia

Back 63

unpleasant abnormal sensation

Front 64

Hyperalgesia

Back 64

Painful syndrome Abnormally painful reaction to a normally non painful stimulus such as touch.

Front 65

Allodynia

Back 65

Pain due to stimulus which does not normally cause pain such as sensitivity to touch.

Front 66

Neuralzia

Back 66

Pain in the distribution of a nerve or nerves.

Front 67

Septic shock
cause

Back 67

toxins in the blood cause Cardiovascular collapse

Front 68

Septic shock
signs and symptoms

Back 68

fever chills skin starts warm becomes cold and clammy, hypotension, mental status changes, oliguiria

Front 69

Septic shock
treatment

Back 69

Antibiotics, oxygen, fluid replacement 2 liters before vasoconstrictive meds given, vasoconstrictive medications

Front 70

Anaphylaxis
signs and symptoms

Back 70

rsspiratory distress, hypertension, fainting, itching, bradycardia, tachycardia, and respiratory arrest

Front 71

Anaphylaxis
Treatment

Back 71

Emergency!
Epinephrine, Diphenhydramine, hydrocortisone, keep airway open

Front 72

Parkinson's disease symptoms

Back 72

Tremor, loss of control of voluntary muscle movements, & rigidity, also may include anxiety, confusion, constipation, and dementia

Front 73

Left sided CHF presents with

Back 73

Congested lungs. Anxiety, restlessness, dyspnea, orthopnea, cough, tachycardia, palpitations, rales in lower lobes, wheezes in bronchi, fatigue, cyanosis

Front 74

Right sided CHF presents with

Back 74

Liver and lower extremities poor blood return. Anorexia, nausea weight gain, Dependent, peripheral edema, weakness, nocturia, oliguria

Front 75

COPD with Emphysema

Back 75

Thin wasted muscles, barrel chest, weak cough, use accessory muscles to breathe, diminished breath sounds

Front 76

COPD with chronic bronchitis

Back 76

Over weight, central cyanosis, Wheezes, little use of accessory muscles

Front 77

COPD
Treatment

Back 77

Bronchodilatiors, corticosteroids, anticholiergics, xanthines, antibiotics, Oxygen if desired

Front 78

Restrictive Lung diseases
Examples

Back 78

Tumors, effusions, diseases that reduce the ability for lungs to expand: myasthenia gravis, diffuse idiopathic interstitial fibrosis,

Front 79

Restrictive Lung diseases
treatments

Back 79

corticosteroids, nebulizers, oxygen, antibiotics if desired

Front 80

Renal Failure
Lab value signs

Back 80

BUN and creatinine rise, GFR <15
can be oliguric or not

Front 81

Gancyclovir

Back 81

Used to prevent CMV retinitis/blindness until final stages of AIDS

Front 82

HAART

Back 82

Highly active antiretroviral therapy-use of 3 or 4 antiretroviral drugs taken in combination has increased survival and quality or life for HIV patients now more chronic disease than terminal.

Front 83

Asterixis

Back 83

Liver flap hand can not stay up tremors and comes down i a few seconds.

Front 84

Medications for Pneumocyctis Carini Pneumonia

Back 84

Clotirimoxazole, pentamidine, trimetrexate, dapsone, bactrim,
Bactrim may be used prophalactically.

Front 85

Glycopyrrolate

Back 85

Robinul decreases secretions, Anticholiergic/antimuscarinic
Used for bowel obstructions

Front 86

Octreotide

Back 86

sandostatin, injectable antidiarrheal decreases motility

Front 87

Naloxone

Back 87

Narcan counteracts opioid overdose

Front 88

Ondansetron

Back 88

Zofran treats Nausea and vomiting caused by chemo also used for liver related uremic and opioid induced pruritis

Front 89

Common Antimuscarinic/Antichoinergic meds

Back 89

Loperimide, scopalamine, atropine, glycoyrrolate (Robinol)