CHPN flashcards
CHPN · 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.
- Karnofsky Performance Status
- A 0-100 scale of functional ability where 100 is normal activity and 0 is death; hospice eligibility often requires 70% or less with documented decline.
- Palliative Performance Scale
- A modified Karnofsky scale scored 0-100% in 10% increments that adds ambulation, activity, self-care, intake, and consciousness; lower scores predict shorter survival.
- FAST Dementia Staging
- Reisberg stages of dementia from 1 to 7; 7a is speech limited to one word, 7b loss of ambulation, 7c loss of sitting, and hospice eligibility is often supported at 7c or beyond.
- Medicare Hospice Benefit Periods
- The first two Medicare hospice benefit periods are 90 days each, followed by unlimited 60-day periods; face-to-face encounters are required before the third period and later recertifications.
- Equianalgesic Morphine Conversion
- Oral morphine 30 mg equals parenteral morphine 10 mg, a 3:1 ratio; apply this conversion when changing routes to avoid underdosing or overdose.
- Breakthrough Pain Dose
- The as-needed dose equals 10% to 20% of the total 24-hour opioid requirement, given every 1 hour as needed for pain that breaks through around-the-clock dosing.
- Transdermal Fentanyl Restrictions
- Transdermal fentanyl is contraindicated in opioid-naive patients, takes 12 to 24 hours to reach effect, lasts 72 hours, and is absorbed faster with fever or heat.
- Naloxone Titration
- For opioid-induced respiratory depression, dilute 0.4 mg in 10 mL saline and give 1 mL (0.04 mg) increments, titrating to adequate breathing rather than full reversal.
- Terminal Secretions Management
- Reposition the patient and give anticholinergics such as glycopyrrolate or scopolamine; avoid deep suctioning and reassure families that the sound does not indicate distress.
- Terminal Delirium First-Line Drug
- Haloperidol is first-line pharmacologic treatment for terminal delirium; benzodiazepines are avoided except in alcohol or benzodiazepine withdrawal and Lewy body dementia.
- Dyspnea Opioid Treatment
- Systemic opioids such as morphine are first-line for refractory dyspnea; supplemental oxygen benefits only patients with documented hypoxemia, not those with normal oxygen saturation.
- Spinal Cord Compression Emergency
- New back pain with weakness, sensory loss, or bladder dysfunction requires urgent MRI and dexamethasone 16 mg daily; outcomes are best when treated before deficits appear.
- SPIKES Protocol
- A six-step framework for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or summary, guiding honest disclosure while responding to emotion.
- NURSE Statements
- Empathic statements that Name the emotion, show Understanding, Respect, and Support, and Explore the concern, acknowledging feelings without false reassurance or premature problem solving.
- POLST Form
- A clinician-signed portable order set for seriously ill patients addressing resuscitation, level of medical intervention, and antibiotics; unlike a living will, it travels across care settings.
- Patient Self-Determination Act
- A 1990 federal law requiring Medicare-funded hospitals, nursing homes, and hospices to inform patients of their right to accept or refuse treatment and to complete advance directives.
- Substituted Judgment Standard
- Surrogates decide by reflecting what the patient would have chosen from stated values and prior wishes; the best interest standard applies when preferences are unknown.
- Rule of Double Effect
- An act with both good and foreseen harmful effects is permissible when the intent is the good effect, the harm is not the means, and the benefit is proportionate.
- Four Ethical Principles
- Autonomy, beneficence, nonmaleficence, and justice; they frame decisions about consent, symptom relief, avoiding harm, and fair use of limited hospice resources.
- Informed Consent Elements
- Valid consent requires decision-making capacity, disclosure of risks, benefits, and alternatives, patient comprehension, and voluntariness free of coercion or undue influence.
- FICA Spiritual Assessment
- A spiritual assessment asking about Faith and belief, Importance of spirituality, spiritual Community, and how care should Address spiritual needs in the plan.
- Caregiver Burden
- The physical, emotional, and financial strain of caring for a seriously ill person, screened with the Zarit Burden Interview and addressed with respite and support services.
- Dignity-Conserving Care
- Chochinov's model addressing illness-related concerns, a dignity-conserving repertoire, and a social dignity inventory; interventions include life review, legacy work, and respectful communication.
- Kubler-Ross Stages
- Denial, anger, bargaining, depression, and acceptance are common reactions to dying and loss; they are not sequential mandatory stages that every person must complete.
- Prolonged Grief Disorder
- A DSM-5-TR diagnosis of persistent intense longing or preoccupation with the deceased plus impairment lasting beyond 12 months in adults and 6 months in children.
- Medicare Bereavement Services
- Hospice must provide bereavement care for up to 13 months after death, including a bereavement risk assessment and an individualized bereavement plan of care.
- Signs of Imminent Death
- Mottled extremities, cool skin, falling urine output, Cheyne-Stokes respirations, terminal secretions, and restlessness typically indicate death within hours to days.
- Hospice Levels of Care
- Routine home care, continuous home care for at least 8 hours in 24, general inpatient care for uncontrolled symptoms, and inpatient respite care limited to 5 consecutive days.
- ICD Deactivation at End of Life
- At end of life, discuss turning off an implantable cardioverter-defibrillator to prevent painful shocks; it is an accepted withdrawal of treatment, not assisted death.
- IDT Plan Review Interval
- Medicare requires the hospice interdisciplinary team to review and update each patient's plan of care at least every 15 days and to document the review.
- Hospice Item Set
- A standardized data set submitted at hospice admission and discharge to the CMS Hospice Quality Reporting Program, used for quality measurement and public reporting.
- CAHPS Hospice Survey
- A CMS survey of family caregivers' hospice experience covering communication, respect, symptom management, and overall rating of the hospice.