hospice palliative care-assessment
TRANSCRIPT
8/4/2019 Hospice Palliative Care-Assessment
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ASSESSMENT OF THE PATIENTASSESSMENT OF THE PATIENT
RECEIVING HOSPICE PALLIATIVE CARERECEIVING HOSPICE PALLIATIVE CARE
Common symptoms experienced by the dying patientare:
� Pain
�
Dyspnea� Nausea
� Vomiting
� Constipation
�
Loss of appetite� Urinary urgency and incontinence
� Insomnia, confusion, delirium
� Anxiety and depression
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PainPain
- A subjective sensation that is influenced
physical, emotional, and social
circumstances.
- May result from a number of conditionssuch as tumor progression, toxicities of
chemotherapy, and radiation, infection, and
muscle ache.
- Pain assessment includes the quality of pain, onset, location, and description of the
discomfort.
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VisualVisual AnalogueAnalogue for Pain Scalefor Pain Scale
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ABCDE Guide to Pain AssessmentABCDE Guide to Pain Assessment
A - ask about the pain regularly. Assess pain
systematically
B - Believe the patient and family in their reports
of pain and what relieves it.
C- Choose pain control options appropriate for
the patient, family, and setting.
D - Deliver interventions in a timely, logical, and
coordinated fashion
E- empower patients and their families. Enable
them to control their course to the greatest
extent possible.
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COMPONENTS OF A COMPREHENSIVECOMPONENTS OF A COMPREHENSIVE
PAIN ASSESSMENTPAIN ASSESSMENT
1. Characterize the pain by location, quality,
intensity, and duration.
2. Describe aggravating and relieving factors
3. Describe how the pain interferes with activitiesof daily living
4. Describe the impact of the pain on your state of
mind
5. Describe responses to previous pharmacologicaland non pharmacological interventions
6. Keep a diary that includes all of the above issues.
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- Refers to an unpleasant awareness of an
increased need to ventilate, such as
breathlessness or difficulty of breathing.- May result from extreme fatigue, anemia,
hypoxia, respiratory muscle fatigue, heart
failure, anxiety, or pain.
DyspneaDyspnea
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Loss of AppetiteLoss of Appetite
- A diminished or nearly lack of interest in food
with early satiety.- May occur from numerous underlying problems,
e.g. side effects of medications, constipation, taste
abnormalities, oral infection, and disease
progression.
Constipation
- Often the result of the using opioid medications for
pain relief.
- Symptoms include hard stools, abdominal distention
and pain, and increased bowel sounds.
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Assessment:Assessment:
-- note the date of the last bowel movementnote the date of the last bowel movement
-- stool characteristicsstool characteristics-- quality of bowel soundsquality of bowel sounds
-- checking the rectum forchecking the rectum for fecalfecal impactionimpaction
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Nausea and VomitingNausea and Vomiting
- May occur as a result of constipation, poor gastricemptying, oral and esophageal lesions, uremia, liver
failure, anxiety, or as a side effect of
chemotherapy.
- Assessment:
� Note the abdominal tenderness
� Auscultate bowel sounds
� Date and consistency of last bowel movement
� Contents and color of vomitus
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Urinary Urgency and IncontinenceUrinary Urgency and Incontinence
Assessment:
� Subjective report of:
-urinary urgency
-nocturia
-incomplete bladder emptying-dysuria
� Localized abdominal pain
� Fullness or tenderness of suprapubic areA
� Fecal impaction
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Insomnia, Confusion and DeliriumInsomnia, Confusion and Delirium
Insomnia ² difficulty falling asleep at night, wake up
without intention during the night, wake up
prematurely from sleep.
Confusion and DeliriumAssessment:
- Note the patient·s reality orientation
- Interaction with others in environment
- Complaints of insomnia
- Delusions or hallucinations
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Anxiety and DepressionAnxiety and Depression
Assessing anxiety:
- Insomnia
- Tremors
- Palpitations
- Irritability- Restlessness
- Appetite change
- Decreased ability to concentrate
Decreased appetite, fatigue, and insomnia are
physical indicators of depression.
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NURSING DIAGNOSESNURSING DIAGNOSES
� Pain
� Ineffective airway clearance
� Constipation
�
Nausea� Disturbed Sleep Pattern
� Acute Confusion
� Anxiety
� Ineffective Coping
� Disturbed Thought Processes
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Nursing Diagnoses related to patient·s caregiver:Nursing Diagnoses related to patient·s caregiver:
1.) Caregiver Role Strain ² the caregiver·s feltdifficulty in in performing the family caregiver role.
Level of readiness of a caregiver:
-willingness to assume the role
-knowledge about the role
-knowledge of the disease process
-knowledge of the treatment regimen
-confidence in the ability to manage care at
home
-knowledge of equipment operation
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2.)Anticipatory Grieving2.)Anticipatory Grieving
- The intellectual and emotional responses and
behaviors by which individuals work through the
process of modifying self-concept based on the
perception of potential loss.
- Expected outcome is grief resolution
- -ability to express feelings about loss
- -verbalize acceptance of the loss
- -describe the meaning of the death- -participate in planning the funeral
- -share the loss w/ significant others
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IMPLEMENTATIONIMPLEMENTATIONComplementary and Alternative Medicine (CAM)
- Involves those therapies that have a focus beyond specificsymptom management.
MANAGING PAIN
Principles of Pain Management:
1. Using the simplest dosing schedules and least invasive
routes.
2. Using the right drug for the specific type of pain
experienced
3. Anticipating, preventing, and treating side effects
4. Giving medications for persistent pain around the clock
5. Respecting individual differences in the treatment plan
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Severe Pain
Strong opioids +
adjuvant agents
Mild to Moderate
Opioid-acetaminophen
Combination +adjuvant agents
Mild Pain
Nonopioids around the Clock
+ adjuvant agents
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ToleranceTolerance ² ² a physiological state characterized bya physiological state characterized by
a decrease in the effects of a drug thata decrease in the effects of a drug that
results in the patient requiring a higherresults in the patient requiring a higher
dose.dose.
Physical DependencePhysical Dependence ² ² the body becomesthe body becomes
dependent on the opioid. It can bedependent on the opioid. It can be
expected within two to three days of expected within two to three days of
initiating an opioid.initiating an opioid.
AddictionAddiction ² ² is a psychological dependence onis a psychological dependence on
medication exhibited by a craving for themedication exhibited by a craving for the
mood altering effects of medication.mood altering effects of medication.
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Withdrawal Symptoms:Withdrawal Symptoms:
�
Anxiety� Irritability
� Chills
� Joint pain
� Lacrimation
� Rhinorrhea
� Diaphoresis
� Nausea
� Vomiting
� Diarrhea
� Abdominal cramps
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Barriers to Pain ManagementBarriers to Pain Management
Problems Related to health Care Professionals
� Poor assessment
� Concern about regulation of controlled
substances
� Fear of patient addiction
� Concern about side effects of analgesics
� Concern about patients becoming tolerant to
analgesics
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Problem Related to Patients and FamilyProblem Related to Patients and Family
CaregiversCaregivers
� Reluctance to report pain
� Concern about distracting the health care
provider from treatment of underlying disease
�
Fear that pain means the disease is worse� Concern about not being a good patient
� Reluctance to take pain medication
� Fear of addiction or of being thought as an addict
� Worries about unmanageable side effects
� Inadequate knowledge of pain management
� Concern about becoming tolerant to pain
medications
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NonpharmacologicalNonpharmacological options:options:
� Physical therapy
� Use of heat or cold treatment
� Distraction
� humor
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ManagingManaging DyspneaDyspnea
� Place the patient in a semi-fowlers position
� Allaying anxiety
�
Providing a cool mist vaporizer� Keeping the room temperature cool
� Administer medications to control dyspnea
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Managing Loss of Appetite, Constipation, NauseaManaging Loss of Appetite, Constipation, Nausea
and Vomitingand Vomiting
NI for GI symptoms:
� Eliminating odors
� Minimizing movement by the patient
� Supplying an emesis container within reach
� Providing oral hygiene
� Circulating room air
� Administering pharmacological agents
� Providing small frequent feedings
� Elevating the head of bed
� Note the color and consistency of foods mostappealing to the patient or best tolerated bypatient
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-- Give medications that can be given prior toGive medications that can be given prior to
meals that improve the appetite.meals that improve the appetite.
-- give yogurt orgive yogurt or nystatinnystatin for cases of oral thrushfor cases of oral thrush
--
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ConstipationConstipation
� Administer stool softeners and stimulants
� Increase the fluid intake
� Increase bulk or fiber in the diet
Nausea
� Administer medications
- drugs that act on chemoreceptive trigger zone
- gastrokinetics
- antihistamines- anxiolytics
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Managing Urinary Urgency andManaging Urinary Urgency andIncontinenceIncontinence
- Placing an indwelling urinary catheter
- Administer medications
- Changing the diuretic regimen
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Managing Insomnia, Confusion, And DeliriumManaging Insomnia, Confusion, And Delirium
� Reverse the day-night sleep patterns by allowingthe patient to be as active as possible duringdaytime hours.
� Hypnotic drugs
� Provide a quiet environment and eliminate
unnecessary stimuli.� Speak clearly in simple short sentences, and focus
on the present
� Well lit surroundings during daytime hours
� Place familiar objects in the environment andsafety measures.
� Medications: Haloperidol, diphenhydramine,chlorpromazine
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Managing Anxiety and DepressionManaging Anxiety and Depression
Explore the patient·s concerns and encourage
them to express those concerns.
Help patient use coping strategies that have been
helpful in the past, non-pharmacological
interventions.
Drug therapy- beta adrenergic blockers id patient
has somatic symptoms.