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How can pressure ulcers be prevented?
padding and/ or occlusive dressings for high-risk areas. Patients should be repositioned ideally every 2 hours.
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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.
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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.
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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.
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Nociceptive pain
presumes normally functioning pain receptors and nerves. Responds well to opiates.
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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.)
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