ACHPN flashcards

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

Interdisciplinary group review interval

Medicare hospice regulations require the interdisciplinary group to review and update each patient's plan of care at least every 15 days.

Volunteer hour requirement

Hospice volunteer hours must equal at least 5% of total patient care hours, and the volunteer program must be documented under the Medicare hospice benefit.

Total pain

Cicely Saunders' concept that suffering at end of life has physical, psychological, social, and spiritual dimensions, each requiring its own assessment and intervention.

SPIKES protocol

Six-step framework for breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions, and Strategy with summary; it structures serious-illness conversations.

NURSE statements

Mnemonic for responding to emotion: Naming, Understanding, Respecting, Supporting, and Exploring; it acknowledges feeling before any further information is offered.

Ask-Tell-Ask

Three-phase technique: elicit what the patient already knows and wants to know, give information in small chunks, then check understanding before continuing.

POLST form

A portable clinician-signed medical order translating the goals of a seriously ill patient into actionable directives such as DNR or comfort-focused treatment; not for healthy adults.

Equianalgesic morphine ratio

Ten milligrams of parenteral morphine equals about 30 mg of oral morphine; this 1:3 ratio anchors most bedside opioid conversion calculations.

Breakthrough pain dosing

A short-acting opioid dose equal to roughly 10-20% of the total 24-hour baseline opioid dose, offered as needed for episodic or incident pain.

Opioid rotation reduction

When switching opioids for poor analgesia or intolerance, reduce the calculated equianalgesic dose by about 25-30% to account for incomplete cross-tolerance.

PAINAD scale

Five-item observational tool scoring breathing, negative vocalization, facial expression, body language, and consolability to rate pain in advanced dementia.

Neuropathic pain adjuvants

Gabapentinoids, tricyclics such as nortriptyline, and serotonin-norepinephrine reuptake inhibitors such as duloxetine are first-line co-analgesics for burning or shooting neuropathic pain.

Dyspnea first-line treatment

Low-dose opioids plus a handheld fan and treatment of reversible causes are first-line; supplemental oxygen helps mainly when hypoxemia is documented.

Terminal secretions management

Anticholinergics such as glycopyrrolate or scopolamine reduce noisy breathing at end of life; repositioning and avoiding deep suctioning also help.

Hypercalcemia of malignancy

Treated with intravenous fluids plus a bisphosphonate such as zoledronic acid; calcitonin works faster but briefly; monitor for confusion, constipation, and polyuria.

Delirium first-line medication

Low-dose haloperidol, olanzapine, or risperidone is used when nonpharmacologic measures fail, always alongside a search for reversible causes such as constipation, drugs, or dehydration.

Methylnaltrexone use

A peripherally acting opioid antagonist given subcutaneously for opioid-induced constipation refractory to standard laxatives; it acts outside the central nervous system and generally preserves analgesia.

FICA spiritual assessment

Screening tool asking about Faith or belief, Importance of those beliefs, spiritual Community, and how care should Address them.

Disenfranchised grief

Grief that is not openly acknowledged or publicly supported, such as after a stigmatized death, the loss of a pet, or the death of a hidden relationship.

Dignity-conserving care

An approach that elicits what sustains a person's sense of worth, then tailors the care environment and interactions to preserve those specific sources of dignity.

Signs of imminent death

Mottled extremities, Cheyne-Stokes breathing, minimal urine output, cool skin, and decreasing responsiveness typically signal death within days to hours.

Palliative sedation

Intentional reduction of consciousness to relieve refractory suffering near end of life; medication is titrated to comfort and death is not the intended effect.

Rule of double effect

An act with a good intended effect, such as relieving pain, may be permissible despite a foreseen harmful effect when intent and proportionality conditions are met.

Hearing at end of life

Hearing is commonly believed to persist near death, so clinicians and families are encouraged to speak to the dying person as though they can hear.

Worden's four tasks of mourning

Accept the reality of the loss, process the pain of grief, adjust to a world without the deceased, and find an enduring connection while moving forward.

Dual-process model

Stroebe and Schut's model describing bereavement as oscillation between loss-oriented grief work and restoration-oriented coping with daily life and new roles.

Prolonged grief disorder

A DSM-5-TR diagnosis requiring persistent, disabling longing or preoccupation with the deceased at least 12 months after death in adults and 6 months in children.

Hospice eligibility prognosis

Medicare requires a prognosis of six months or less if the illness follows its expected course, with recertification at each subsequent benefit period.

Decision-making hierarchy

When a patient lacks capacity, surrogates follow written directives first, then substituted judgment, then best interests, in an order set by state law.

Capacity versus competence

Capacity is a clinical determination of the ability to understand, appreciate, reason, and choose; competence is a legal status determined by courts.

PDSA cycle

Plan-Do-Study-Act: a rapid-cycle improvement method for testing a small change, studying the result, then adopting, adapting, or abandoning it.

QI versus research

Quality improvement aims to improve local practice and usually needs no IRB review, while research seeks generalizable knowledge and requires formal oversight and consent.