Palliative and End of Life Care

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Palliative and End of Life Care
2010-10-12 23:41:05
Palliative End Life Care Essentials Family Medicine

Chapter 7 from Essentials of Family Medicine
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  1. How can pressure ulcers be prevented?
    padding and/ or occlusive dressings for high-risk areas. Patients should be repositioned ideally every 2 hours.
  2. What often causes edema in advanced illness?
    • hypoalbuminemia which leads to decreased oncotic pressure.
    • Some pts may have lymphatic or venous obstruction from compression by a primary or metastatic tumor or postsurgical changes.
  3. What is the most effective treatment for the symptomatic relief of dyspnea?
    • Opioids! Low-dose tx with careful titration is safe and effective.
    • Axiolytics (short acting benzo such as Xanax) also effective.
  4. Adverse effects of opiates that should be monitored for and treated.
    • Constipation: Tx w/ stimulant (bisacodyl) or osmotic (lactulose) laxatives
    • Sedation: Tx change meds or route of admin. Psychostimulants (methyphenidate-Ritalin). Peristent sedation with inadequately releived pain implies need for adjuvant analgesics.
    • Nausea and vomiting: tolerance often develops, antiemetics(promethazine, metoclopramide)
    • Respiratory depression: appropriate titration by pain response and careful monitoring of the patient's level of alertness.
  5. Nociceptive pain
    presumes normally functioning pain receptors and nerves. Responds well to opiates.
  6. Neuropathic pain
    presumes abnormal function of either the peripher or central nervous system. May require opiates and adjuvant analgesics. (corticosteroids-pain caused by nerve compression, edema, acute neuropathic pain, and metastatic bone lesions. TCA's or anticonvulsants particularly gabapentin for neuropathic pain.)