palliative care Test Questions and
Answers| Already Passed
when are tube feedings helpful and not helpful and why - ✔✔helpful if a patient is having significant
weight loss and is considered to have the potential to recover
not helpful for end of life because "starving to death" does not happen as dying patients do not
experience hunger and are often satisfied with small of amounts of liquids or food that can be provided
by hand
medications that can contribute to wasting syndromes seen in end of life - ✔✔TNF agents and
other cytokines
Why do we not tend to improve nutrition at end of life - ✔✔- food is less appealing
- body and digestive system is slowing down and cannot handle food
- patients sleep more
- altered physiology and body chemistry- mild sense of euphoria (sometimes mistaken for improvement)
- improve nutrition is ineffective
- weight loss is common and needs to be expected
how do we change nutrition in end of life? - ✔✔eliminate dietary restrictions
provide favorite foods
smaller, more frequent, hand feed
mosten lips and mouth
,how are tube feeds utilized in end of life care - ✔✔typically not used - does not lead to a
better quality of life or longer life
do not facilitate wound healing or prevent pressure ulcers in end of life
patients may try to remove the device
tube feeding at end of life increase risk of -
✔✔aspiration diarrhea
other complications
what is associated with end stage conditions - ✔✔nausea
what is the causes of constipation - ✔✔constipation may be the cause of nausea, especially as
pain medications are increased
what medication should not be used to treat nausea if constipation is the suspected cause -
✔✔anticholinergics- make constipation worse
1) promethazine
2) prochlorperazine
difference in using anti-nausea medications in geriatrics vs end of life - ✔✔in geriatrics, we tend
to avoid many anti-nausea medications due to the SE profile such as D2 blocker, anticholinergics
in end of life, we are more worried about comfort than side effects, so these meds become appropriate
use of Haloperidol in end of life - ✔✔1) nausea treatment
-strong D2 blockade
- often still use Haloperidol after trying other meds
, - still tend to avoid in Parkinson's patients
2) delirium
- only an issue if at risk of harming self or others
- dont' need to treat pleasant hallucination
___ is normal in end of life, and we do not need to start meds for this - ✔✔confusion
medications that may contribute to delirium and may be appropriate to d/c in end of life -
✔✔anticholinergics
benzos
CNS depressants
what may contribute to loss of PO route in end of life - ✔✔difficulty swallowing
severe nausea
what can be used if patient is NOT opioid naive and what is the dosing - ✔✔fentanyl patch
at least 60mg of morphien per day or equivalent of 25mcg/hr patch
why does the fentanyl patch still cause nausea like PO opioids - ✔✔nausea from opioids is a
systemic effect
in what patient population is a fentanyl patch not typically effective and why - ✔✔not be effective
in cachectic patients
may not absorb well in patients without body fat
Answers| Already Passed
when are tube feedings helpful and not helpful and why - ✔✔helpful if a patient is having significant
weight loss and is considered to have the potential to recover
not helpful for end of life because "starving to death" does not happen as dying patients do not
experience hunger and are often satisfied with small of amounts of liquids or food that can be provided
by hand
medications that can contribute to wasting syndromes seen in end of life - ✔✔TNF agents and
other cytokines
Why do we not tend to improve nutrition at end of life - ✔✔- food is less appealing
- body and digestive system is slowing down and cannot handle food
- patients sleep more
- altered physiology and body chemistry- mild sense of euphoria (sometimes mistaken for improvement)
- improve nutrition is ineffective
- weight loss is common and needs to be expected
how do we change nutrition in end of life? - ✔✔eliminate dietary restrictions
provide favorite foods
smaller, more frequent, hand feed
mosten lips and mouth
,how are tube feeds utilized in end of life care - ✔✔typically not used - does not lead to a
better quality of life or longer life
do not facilitate wound healing or prevent pressure ulcers in end of life
patients may try to remove the device
tube feeding at end of life increase risk of -
✔✔aspiration diarrhea
other complications
what is associated with end stage conditions - ✔✔nausea
what is the causes of constipation - ✔✔constipation may be the cause of nausea, especially as
pain medications are increased
what medication should not be used to treat nausea if constipation is the suspected cause -
✔✔anticholinergics- make constipation worse
1) promethazine
2) prochlorperazine
difference in using anti-nausea medications in geriatrics vs end of life - ✔✔in geriatrics, we tend
to avoid many anti-nausea medications due to the SE profile such as D2 blocker, anticholinergics
in end of life, we are more worried about comfort than side effects, so these meds become appropriate
use of Haloperidol in end of life - ✔✔1) nausea treatment
-strong D2 blockade
- often still use Haloperidol after trying other meds
, - still tend to avoid in Parkinson's patients
2) delirium
- only an issue if at risk of harming self or others
- dont' need to treat pleasant hallucination
___ is normal in end of life, and we do not need to start meds for this - ✔✔confusion
medications that may contribute to delirium and may be appropriate to d/c in end of life -
✔✔anticholinergics
benzos
CNS depressants
what may contribute to loss of PO route in end of life - ✔✔difficulty swallowing
severe nausea
what can be used if patient is NOT opioid naive and what is the dosing - ✔✔fentanyl patch
at least 60mg of morphien per day or equivalent of 25mcg/hr patch
why does the fentanyl patch still cause nausea like PO opioids - ✔✔nausea from opioids is a
systemic effect
in what patient population is a fentanyl patch not typically effective and why - ✔✔not be effective
in cachectic patients
may not absorb well in patients without body fat
