Palliative Care and End of Life

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Palliative Care and End of Life
2014-03-07 17:48:19
Palliative Care End Life
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  1. Palliative Care
    • Interdisciplinary specialty that aims to relieve suffering and improve QOL of patients w/ advanced illness and their families
    • Provided any time during illness (not just at very end)
    • May be combined w/ curative care
  2. Hospice
    • Prognosis of 5 months or less
    • Focus on comfort care (really no active treatment)
  3. Amyotrophic Lateral Sclerosis (ALS)
    • Lou Gehrig's Disease
    • Progressive neurodegenerative disorder leading to total functional impairment
    • Death from respiratory failure
    • Upper and lower motor dysfunction
    • Insidiously progressive (not relapsing/remitting)
    • Riluzole - only drug shown to increase life expectancy (2-3 months)
  4. Parkinson's Disease (PD)
    • Dopamine depletion of basal ganglia circuits characterized by gradually worsening symptoms over a period of years
    • Dementia and swallowing impairments = common!
    • 70% of deaths due to aspiration pneumonia
    • Motor symptoms: tremor, bradykinesia, rigidity, and motor complications of levodopa (dyskinesias)
    • Levodopa and dopamine agonists treat symptoms but do not alter disease course
    • Mean survival 6-12 years
    • Time to functional dependency 3-5 years
  5. Parkinson's Syndromes
    • Progressive Surpanuclear Palsy
    • Multiple System Atrophy
  6. Progressive Supranuclear Palsy
    • Severe axial rigidity
    • Bradykinesia
    • Micrographia
    • Vertical gaze palsy
    • Postural instability
    • Falls
    • Early frontal cognitive impairment
  7. Multiple System Atrophy
    • Akinesia
    • Rigidity
    • Cerebellar ataxia
    • Severe autonomia
    • Orthostasis
    • Falls
    • Urinary dysfunction
  8. Multiple Sclerosis
    • Inflammatory, demyelinating disease of CNS
    • Likely autoimmune
    • Most often relapsing/remitting (can be progressive)
    • Variety of neurologic s/s (sensory, motor, visual loss)
  9. Motor Symptoms in ALS and MS: Weakness & Spasticity
    • MS: more severe in LE, may cause difficulty walking
    • ALS: gradually progressive through all muscle groups, spares sphincter control & eye movements
  10. Pain
    • Common! (and multifactorial)
    • ALS: immobility, spasticity, leg cramps
    • MS: neuropathic syndromes (burning feet/legs, Lhernmitte's phenomenon, trigeminal neuralgia, painful tonic spasms)
    • PD: rigidity, dystonia, dyskinesia, neuropathic symptoms (numbness, tingling)
  11. Pain Treatment for All
    • Non-Pharmacologic: repositioning, ROM exercises, massage, supportive mattresses, WC cushions
    • Pharmacologic: Acetaminophen & NSAIDs (for mild pain), opiod analgesics for mod/severe pain
  12. Pain Treatment for ALS
    • Non Pharmacologic: leg cramps = calf stretching, tonic water
    • Pharmacologic: treat spasticity (baclofen or tizanidine, quinine sulfate for severe cases)
  13. Pain Treatment for MS
    • Non-Pharmacologic: stress reduction, TENS, avoidance of heat exposure if heat-exacerbated symptoms
    • Pharmacologic: neuropathic symptoms --> anticonvulsants, tricyclic antidepressants, SSRI
  14. Pain Treatment for PD
    • Non-Pharmacologic: PT
    • Pharmacologic: adjust levodopa or dopamine agonists; anticonvulsants and tricyclic antidepressants for neuropathic symptoms