Certification for Hospice and Palliative Nursing Top Predicted Questions and Answers 2024

xerostomia - Dry mouth syndrome, leads to decreased swallowing ability, increased dental caries, gum, tongue and oral lesions, infections, bad breath, changes in taste and alterations in speech and voice functions. Social decline pyschosocial complication. xerostomia non-pharmacological treatments - oral swabs, peppermint water, vitamin c, chewing gum/mints, acupuncture, diet modification, humidity Percentage of HIV infection related pain - 50% directly related to infection of 30-97% of AIDS patient experiencing pain Post stroke pain - 32-42% experienced at 4-6 months post cva 11-21% experienced at 12-16 months post cva Types of common post CVA pain - Mechanical shoulder pain-common Allodynia= Painful response to normally innocuous stimuli Hyperalgesia =Decreased temperature sensation deep, superficial, and or severe -coxib drugs - withdrawn from market due to adverse effects associated with cardiovascular system Conversion method from oral dose long acting to oral dose short acting - 24 h total of long acting divided by q4h administration plus breakthrough dose of 10-15% of 24 hour total given q2h prn Medication dosage alteration based on increased use of PRN dosage - Add total dosage for PRN use by patient and divide by 2 for amount of increase needed to long acting med Primary factors for subcutaneous infusion - 1. Circulatory status 2. Patient monitoring 3. Infusion site- amount of subcutaneous tissue Calculating breakthrough dose of short acting medication - 10-20% of daily total q2h prn Treatment for neuropathic pain - Tricyclic antidepressants Anticonvulsants SSRI Serotonin-norepinephrine reuptake inhibitors Anti-convulsants Starting dose nortryptiline and desipramine - 10-25 mg at hs titrated up by 10-25 mg every few days to max of 75-150 mg qd. May take 3-7 days to see effects. To prevent double effect - When changing opioid decrease dose of new drug by 25% to account for incomplete cross tolerance. Duloxetine - SSRI for treating neuropathic pain and depression Side effects of Tricyclic antidepressants - Sedation, orthostatic hypotension, urinary retention, cardiovascular impairment Gabapentin- normal dosing range for effectiveness - 900-1800 mg/d in 3 divided doses Side effects of anticonvulsants - Ataxia, dizziness, sedation. Gabapentin specifically has increased incident of dependent edema.