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14 Cards in this Set
- Front
- Back
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Receiving adequate pain management
Avoiding prolongation of dying achieving a sense of control relieving burdens strengthening relationships ... which of these are goals that pts say they want (w/ chronic illness)? |
All of 'em.
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Hospice is offered in the last ___ of life? Can it be combined with dz-modifying txts? Where does it primarily take place?
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6m
No. Homes, nursing homes, and assisted living centers. |
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What is Dyspnea? Must it be associated w/ hypoxia, tachypnea, and/or accessory muscle use?
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"subjective experience of breathing discomfort"
no. |
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What physiology of dyspnea could be understood w/ a blood gas?
Can peripheral mechanoreceptors send afferent feedback on function "mismatch" --> dyspnea? Can dyspnea be psychogenic? |
Low pO2 / high pCO2 (pH) --> afferent input from peripheral/central arterial chemoreceptors to respiratory center (medulla) --> efferent demand to muscles controlling aveolar ventilation
yes. yes. |
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Which cause of dyspnea is characteristically associated with a "tightness" in the chest?
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Asthma
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Are txts for dyspnea disease specific or sx specific?
Is O2 helpful in pts whose dyspnea is NOT caused by hypoxia? What is the primary type of medication that we use to relieve the feeling of dyspnea? |
there are txts for both, so to speak.
No. Opioids. (narcotics) Corticosteroids Benzodiazepines (if there is an anxiety component) |
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What effect of opioids ALWAYS precedes the respiratory depression seen in some w/opioid use?
How does this play into using opioids for dyspnea txt? |
Sedation
Pt can be monitored for sedation, and if that doesn't happen, then the pt will be safe from respiratory depression as well. |
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Are upper airways secretions problematic in dyspnea?
How you we txt airway secretions generally? If they're related to fluid overload? If they're thick? If they're thin? |
Yes, they can be, but don't always have to be.
Positioning / RT, humidification, suction Reduce IV fluids Thick: guaifenesin, albuterol, acetylcysteine Thin: muscarinic receptor blockade (scopolamine, hyoscyamine, glocopyrrolate, atropine); ipratropium. |
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What is the BODE index used to help with prog? What are the 4 components?
Is SOB predictive of life expectancy? Is pain? |
COPD
BMI <21 (1) FEV1 36-49% (2) or <35% (3) Dyspnea MMRC score of 3 (2) or 4 (3) 6 min walk: 150-249m (2) or <149m (3) Yes, no. |
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Hospital re-admission within 2 mos
ADL dependency 3+ Weight loss of > 5 lbs in 2 months Albumin < 2.5 Cor pulmonale PO2 < 55 mmHg on oxygen ...all are what? do these have a good sensitivity? Specificity? |
hospice referral criteria for COPD
Low sensitivity, decently high specificity. |
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vasopressor use
hemodialysis platelets <150 age >49 .. what are these mortality risk factors for? |
mortality risk factors for prolonged respiratory failure
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Non-small cell lung cancer has a __ median survival?
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5y median survival
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Should we talk about prog in specific time frames?
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No. But we CAN and SHOULD use some time frames.
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Can enhanced communication improve ICU care? Ventilator use? Mortality?
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Yes, yes.
No. |
