ABP Pediatric Palliative flashcards
ABP Pediatric Palliative · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Concurrent care
- Medicaid provision allowing children under 21 to receive hospice services while continuing curative or life-prolonging treatment; adults must forgo curative care to elect hospice.
- Hospice prognosis criterion
- Eligibility generally requires a life expectancy of six months or less if the illness runs its expected course, certified in periods of 90 days and then 60 days.
- Palliative care definition
- Interdisciplinary care for patients with serious illness that relieves suffering and improves quality of life, provided at any stage and alongside disease-directed treatment.
- Hospice levels of care
- Routine home care, continuous home care for at least eight hours a day, general inpatient care for uncontrolled symptoms, and respite care limited to five consecutive days.
- Interdisciplinary group meeting
- Medicare hospice conditions of participation require the interdisciplinary group to meet at least every 14 days to review and revise each patient's plan of care.
- Perinatal palliative care
- Care beginning at prenatal diagnosis of a life-limiting fetal condition, spanning birth planning, comfort-focused delivery, memory-making, and bereavement support for the family.
- FLACC scale
- Behavioral pain tool scoring Face, Legs, Activity, Cry, and Consolability from 0 to 10, validated for children about two months to seven years and for those unable to self-report.
- WHO pediatric analgesic ladder
- Two steps: mild pain treated with acetaminophen or an NSAID; moderate-to-severe pain treated with an opioid, with adjuvant drugs added at either step.
- Equianalgesic morphine conversion
- 10 mg IV morphine equals 30 mg oral morphine, 1.5 mg IV hydromorphone, 7.5 mg oral hydromorphone, and 100 mcg IV fentanyl; reduce the new drug 25-50% for cross-tolerance.
- Codeine contraindication
- Contraindicated in children under 12 years and after tonsillectomy or adenoidectomy at any age because variable CYP2D6 metabolism can cause fatal respiratory depression.
- Opioid-induced neurotoxicity
- Myoclonus, hyperalgesia, and agitated delirium from accumulating morphine metabolites; management is opioid rotation plus hydration rather than escalating the same opioid dose.
- Naloxone for opioid respiratory depression
- Titrate small boluses of 1-5 mcg/kg to restore adequate breathing while preserving analgesia; full reversal risks severe pain, agitation, and pulmonary edema in opioid-tolerant children.
- Dyspnea first-line treatment
- Low-dose opioids; oxygen helps only documented hypoxemia; fans, positioning, and benzodiazepines address the anxiety component, and dexamethasone helps tumor-related dyspnea.
- Neuropathic pain adjuvants
- Gabapentin at 5-10 mg/kg/day divided three times daily, amitriptyline, or ketamine added to opioids; response is judged over days to weeks, not hours.
- SPIKES protocol
- Six steps for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or summary; a flexible framework rather than a rigidly sequential script.
- NURSE statements
- Empathic responses: Naming the emotion, Understanding, Respecting, Supporting, and Exploring; they signal presence without prematurely offering solutions or reassurance.
- Ask-Tell-Ask
- Elicit what the family already knows and wants to know, deliver one small piece of information, then check understanding before continuing to the next piece.
- Child assent
- Developmental agreement from a minor, typically from about seven years, accompanying parental permission; dissent is weighed seriously but does not legally override parental consent.
- Developmental concept of death
- Children under two have no concept; ages two to six treat death as temporary; ages six to eleven grasp finality but not universality; from about eleven, death becomes abstract and personal.
- Wish statement response
- Answering a hope-laden request with 'I wish...' acknowledges emotion and shared goals without promising an outcome that medicine cannot deliver.
- Total pain
- Saunders' concept that suffering has physical, psychological, social, and spiritual dimensions that interact, so relieving nociception alone may fail to relieve the child's pain.
- FICA spiritual history
- Four-item screen: Faith or belief, Importance of spirituality, faith Community involvement, and how care should Address spiritual needs in the treatment plan.
- Best interests standard
- Decision standard for a child who has never had capacity: weigh benefits and burdens to the child rather than guessing what the child would have chosen.
- Withholding versus withdrawing
- Ethically equivalent when the goal is comfort; intent and proportionality, not the act-omission distinction, determine whether limiting life-sustaining treatment is permissible.
- Dual Process Model
- Stroebe and Schut's model of grieving as oscillation between loss-oriented coping such as yearning and crying, and restoration-oriented coping such as daily tasks and new roles.
- Potentially inappropriate treatment
- Preferred term for futility; resolution uses goal clarification, time-limited trials, ethics consultation, and institutional due process before any unilateral limitation of treatment.
- Signs of active dying
- Mottling, cool extremities, oliguria, Cheyne-Stokes breathing, apnea, terminal secretions, obtundation, and loss of interest in eating or drinking over hours to days.
- Anticipatory prescribing
- Stocking a just-in-case set of subcutaneous medicines before the terminal phase: opioid, benzodiazepine, anticholinergic, antipsychotic, and antipyretic, so symptoms are treated without delay.
- Terminal extubation preparation
- Discontinue neuromuscular blockers completely and premedicate with an opioid plus benzodiazepine, then remove the tube while continuing to treat dyspnea and secretions.
- Prolonged grief disorder
- DSM-5-TR diagnosis requiring persistent, intense, functionally impairing grief at least 12 months after the death in adults and at least 6 months in children and adolescents.
- Highest bereavement risk
- Death of a child, sudden or violent death such as suicide, homicide, or overdose, prior psychiatric illness, poor family functioning, and a sense of unpreparedness raise complicated-grief risk.
- Hospice bereavement benefit
- Medicare requires hospice programs to provide bereavement services to the family for 13 months after the death, with risk-stratified outreach to high-risk survivors.