ABA Palliative Care flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Hospice eligibility prognosis

Under US Medicare, a prognosis of six months or less if the terminal illness runs its normal course, certified by the hospice medical director and attending physician.

Palliative care definition

Interdisciplinary care focused on relieving suffering and improving quality of life for patients with serious illness, appropriate at any stage and combinable with curative treatment.

Total pain concept

Cicely Saunders' framework holding that pain has physical, psychological, social, and spiritual components, all of which must be assessed and addressed for effective relief.

Equianalgesic conversion

Dose equivalence used to switch opioids; oral morphine 30 mg approximates oral oxycodone 20 mg, oral hydromorphone 7.5 mg, or IV morphine 10 mg.

Incomplete cross-tolerance

Reduced responsiveness to a new opioid after switching, so the calculated equianalgesic dose is typically decreased by 25 to 50 percent when rotating.

Naloxone use

Short-acting opioid antagonist that reverses respiratory depression and sedation from opioids, titrated intravenously or intramuscularly; it does not reverse opioid-induced constipation.

Methylnaltrexone indication

Peripherally acting mu-opioid antagonist used for opioid-induced constipation that has not responded to laxatives in patients with advanced illness.

Dyspnea treatment at end of life

Low-dose opioids are first-line for refractory dyspnea; supplemental oxygen helps only patients with documented hypoxemia, not normoxemic patients.

Terminal delirium management

Identify and reverse causes, minimize deliriogenic medications, provide environmental support, and use low-dose antipsychotics for distressing agitation when nonpharmacologic measures fail.

Palliative Performance Scale

Tool scoring ambulation, activity, self-care, intake, and consciousness from 0 to 100 percent, used to estimate functional status and prognosis in advanced illness.

Surprise Question

Prognostic prompt asking whether the clinician would be surprised if the patient died within twelve months; a negative answer suggests palliative or hospice referral.

Opioid-induced neurotoxicity

Syndrome of myoclonus, hyperalgesia, delirium, and sedation from opioid metabolite accumulation, often in renal failure; managed by hydration, opioid rotation, or dose reduction.

Corticosteroids in advanced cancer

Used for appetite stimulation, fatigue, bone pain, and raised intracranial pressure; dexamethasone is common, with monitoring for hyperglycemia and delirium.

Anticholinergic for secretions

Glycopyrrolate or scopolamine reduces noisy respiratory secretions (death rattle) in dying patients; repositioning and limiting fluids also help.

Bisphosphonates in bone metastases

Zoledronic acid or denosumab reduces skeletal-related events and bone pain in metastatic cancer; monitor renal function and calcium.

Living will

Written document stating a person's preferences for future medical treatment, used when the patient lacks decision-making capacity and no agent is available.

Durable power of attorney

Legal document designating a health care agent to make medical decisions when the patient loses capacity; agent should apply substituted judgment.

POLST form

Portable medical order set documenting treatment preferences for seriously ill patients, covering resuscitation, hospitalization, and artificial nutrition; valid across care settings.

Substituted judgment standard

Decision standard in which the surrogate chooses what the patient would have wanted, based on known values and prior statements.

Best interests standard

Decision standard used when the patient's wishes are unknown, choosing what a reasonable person would consider beneficial and least burdensome.

Withholding versus withdrawing

Ethically and legally equivalent; discontinuing a life-sustaining treatment is permissible under the same conditions as never starting it.

Double effect principle

Doctrine permitting an action with a good intended effect (symptom relief) and a foreseeable bad effect (hastened death), provided the bad effect is not the means or intent.

Palliative sedation

Use of sedatives to unconsciousness to relieve refractory symptoms in a dying patient; intent is symptom relief, distinguishing it from euthanasia or assisted death.

Terminal restlessness

Agitation and confusion near death, often from delirium, pain, urinary retention, or medication effects; treated by addressing causes and using antipsychotics or benzodiazepines.

Prolonged grief disorder

Persistent, disabling yearning or preoccupation with the deceased lasting at least twelve months after the death in adults, causing significant impairment.

Hospice interdisciplinary team

Core team including physician, nurse, social worker, chaplain, aide, volunteer coordinator, and bereavement counselor, meeting regularly to plan patient care.

FICA spiritual assessment

Screening tool asking about Faith, Importance of beliefs, Community involvement, and how care should Address spiritual needs.

Bereavement support

Hospice-provided follow-up for family for at least one year after death, including counseling, support groups, and risk assessment for complicated grief.

Family meeting in palliative care

Structured discussion with patient and family covering illness understanding, goals of care, prognosis, and treatment options, documented and shared with the team.

Capacity assessment

Determining ability to make a specific medical decision by evaluating understanding, appreciation, reasoning, and expression of a choice.

Artificial nutrition at end of life

Parenteral or enteral feeding in dying patients does not improve comfort and may increase secretions and aspiration; decisions should reflect patient goals.

Do-not-resuscitate order

Physician order directing that CPR not be attempted; it does not by itself limit other treatments such as antibiotics, hydration, or comfort care.