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Sg chpn hpna week 3 symptom management

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Sheila Grant, MSN, RN, CHPN
Sheila Grant, MSN, RN, CHPN
1 of 57
CLINICAL REVIEW FOR THE GENERALIST HOSPICE & PALLIATIVE NURSE Symptom Management WEEK 3
Nat’l. Consensus Project ,[object Object],[object Object],[object Object]
Common EOL Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],For each symptom, we will look at: ETIOLOGY, ASSESSMENT, NON-PHARM. + PHARM. TREATMENTS, AND PT./FAM. TEACHING.
1. Anorexia/Cachexia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Non-Pharm. Interventions for Anorexia/Cachexia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Interventions for Anorexia/Cachexia Class of drug Examples Comments Gastrokinetic agents Metoclopramide (Reglan) Useful w/ c/o nausea + early satiety (“I feel full”) Corticosteroids Dexamethasone (Decadron) Effective in short-term (w/side effects) Progesterone Analogs (hormonal treatment) Megestrol acetate (Megace) Somewhat effective for some pts. (expensive) Cannabinoids Dronabinol (Marinol) Effective in low doses Alcohol Beer or sherry May improve appetite + morale in some pts. Vitamins Multivits., Vit. C Anecdotal evidence for improved appetite (placebo?)
Pt./Family Education ,[object Object],[object Object],[object Object],[object Object],[object Object]
2. Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Third-Spacing ,[object Object],[object Object],[object Object]
Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Family Teaching: Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object]
3. Nausea & Vomiting ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Non-Pharmacological Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacological Treatments Cause Treatment Slow gastric emptying Prokinetic agent (Metoclopramide, Domperidone) Chemical (opioid side-effect) Haloperidol, Droperidol Vestibular (vertigo, dizziness) Antihistamine (Dimenhydrinate/dramamine) Motion sickness Anticholinergic (scopolamine, hysoscyamine/Levsin) Nausea w/anxiety Benzodiazepine (lorazepam) Intestinal Obstruction Octreotide (sandostatin) ,[object Object],Steroid (Dexamethasone/Decadron--in combination w/ other drugs)
Pt./Family Teaching: N/V ,[object Object],[object Object],[object Object],[object Object]
4. Bowel Obstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Be Careful ,[object Object],[object Object]
Pt./Family Teaching: B.Obstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
5. Constipation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioid-Induced Constipation (OIC) ,[object Object],[object Object],[object Object]
New Drug: Relistor (methylnaltrexone ) Naloxone Relistor (naloxone w/ + charge on Nitrogen atom)
Methylnaltrexone: Treats Opioid-Induced Constipation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pt./Family Teaching: Constipation ,[object Object],[object Object],[object Object],[object Object]
6. Diarrhea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pt./Family Teaching: Diarrhea ,[object Object],[object Object],[object Object],[object Object]
7. Anxiety ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TREATMENTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pt./Family Teaching: Anxiety ,[object Object],[object Object],[object Object],[object Object],[object Object]
8. Delerium/Agitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Checklist for Assessing Terminal Agitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Correcting the Causes of Delerium/Agitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pt./Family Teaching ,[object Object],[object Object],[object Object],[object Object],[object Object]
9. DEPRESSION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for Depression ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pt./Family Teaching for Depression ,[object Object],[object Object],[object Object],[object Object],[object Object]
10. Dyspnea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pt./Family Teaching for Dyspnea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
11. Noisy Respirations/Secretions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pt. /Family Teaching on Secretions ,[object Object],[object Object],[object Object]
12. Fatigue ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PT./Family Teaching on Fatigue ,[object Object],[object Object],[object Object],[object Object],[object Object]
13. Pressure Ulcers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SHEAR ,[object Object],[object Object]
Shearing is Caused by: ,[object Object],[object Object],[object Object]
Wound Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Unstageable wound— cannot see base of wound – Black eschar in wound bed-needs debriding Dry, Black eschar on heel—do not remove Do not “reverse stage”—As a wound heals, it remains the same stage—a stage 3 is “a healing stage 3”, not a stage 2 .
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pt./Family Teaching ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
QUESTIONS?

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Sg chpn hpna week 3 symptom management

  • 1. CLINICAL REVIEW FOR THE GENERALIST HOSPICE & PALLIATIVE NURSE Symptom Management WEEK 3
  • 2.
  • 3.
  • 4.
  • 5.
  • 6. Pharmacologic Interventions for Anorexia/Cachexia Class of drug Examples Comments Gastrokinetic agents Metoclopramide (Reglan) Useful w/ c/o nausea + early satiety (“I feel full”) Corticosteroids Dexamethasone (Decadron) Effective in short-term (w/side effects) Progesterone Analogs (hormonal treatment) Megestrol acetate (Megace) Somewhat effective for some pts. (expensive) Cannabinoids Dronabinol (Marinol) Effective in low doses Alcohol Beer or sherry May improve appetite + morale in some pts. Vitamins Multivits., Vit. C Anecdotal evidence for improved appetite (placebo?)
  • 7.
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  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23. New Drug: Relistor (methylnaltrexone ) Naloxone Relistor (naloxone w/ + charge on Nitrogen atom)
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
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  • 45.
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  • 48.
  • 49.
  • 50.
  • 51.
  • 52.
  • 53.
  • 54. Unstageable wound— cannot see base of wound – Black eschar in wound bed-needs debriding Dry, Black eschar on heel—do not remove Do not “reverse stage”—As a wound heals, it remains the same stage—a stage 3 is “a healing stage 3”, not a stage 2 .
  • 55.
  • 56.

Editor's Notes

  1. Shear is caused by gravity pushing down on the body and resistance (friction) between the patient and a surface, such as the bed or chair. E.g. elevation of head of bed, and sliding down in chair.