CHPN key terms

A 0-to-100 scale on which a clinician rates a patient's ability to carry out normal activities and self-care; lower scores mean greater dependence and are used to gauge prognosis and service eligibility.

A tool that scores ambulation, activity, self-care, oral intake, and level of consciousness from 0% to 100%, used to describe functional decline and help estimate prognosis in serious illness.

A brief patient-rated tool that scores nine common symptoms, such as pain, tiredness, nausea, and anxiety, on 0-to-10 scales so clinicians can track distress and response to treatment over time.

The idea that suffering near the end of life comes from several sources at once, including physical, emotional, social, and spiritual, so relief requires attention to all of them rather than analgesia alone.

Pain arising from actual or threatened damage to body tissue, often described as aching, throbbing, or pressure-like, and usually responsive to opioids and non-opioid analgesics.

Pain caused by injury to or dysfunction of the nervous system, often burning, shooting, or tingling, and usually needing adjuvants such as gabapentin or certain antidepressants along with opioids.

A brief spike of pain that occurs even though baseline pain is otherwise well controlled; it usually starts quickly and is treated with a short-acting rescue dose of analgesic.

The dose of one analgesic that produces pain relief roughly equal to a given dose of another, used as a reference point when converting a patient from one opioid to another.

Switching a patient from one opioid to another using an equianalgesic conversion, often with a dose reduction for incomplete cross-tolerance, to improve analgesia or reduce troublesome side effects.

A drug whose main purpose is not pain relief, such as an anticonvulsant, antidepressant, or corticosteroid, but which eases certain pain types, especially neuropathic or bone pain.

The uncomfortable sensation of difficult or labored breathing; it is subjective and can be severe even when oxygen saturation and respiratory rate appear normal.

An acute, fluctuating disturbance of attention and awareness, often triggered by medications, infection, or organ failure, that is common near the end of life and is sometimes reversible.

Constipation caused by opioid therapy that does not resolve with continued use, so patients usually need a scheduled bowel regimen, typically including a stimulant laxative, started when the opioid is begun.

Involuntary weight loss, muscle wasting, and poor appetite driven by the illness itself, which does not improve with forced calories and is managed with small appealing meals and symptom control.

Sudden, brief muscle jerks or twitches that can occur with high opioid doses, kidney failure, or metabolic imbalance; treatment may include dose adjustment, hydration, or a benzodiazepine.

A legal document completed while a person can still decide, stating preferences for future medical care or naming someone to make decisions if the person later becomes unable to speak.

A person appointed in a legal document to make medical decisions for someone who has lost decision-making capacity; also called a durable power of attorney for health care.

A portable medical order form, signed by a clinician with patient or surrogate agreement, that directs emergency and end-of-life treatments such as resuscitation, hospitalization, and antibiotics for seriously ill people.

A six-step framework for delivering bad news: setting up the conversation, assessing the patient's perception, inviting information needs, giving knowledge, addressing emotions, and summarizing a plan.

A discussion among patient, family, and clinicians about what matters most and which treatments fit the patient's values, prognosis, and acceptable quality of life.

A patient's voluntary agreement to a treatment after being told its purpose, risks, benefits, and alternatives, given by someone with decision-making capacity or by an authorized surrogate.

A clinician's judgment that a patient can understand relevant information, appreciate the consequences, reason about options, and communicate a choice about their own care.

The standard in which a surrogate decides as the patient would have decided, based on the patient's known values and statements, rather than on what the surrogate personally believes is best.

A judgment that a treatment cannot achieve its intended physiologic goal or produce any benefit the patient would value, which may justify withholding or stopping that treatment.

The principle that an action with a good intended effect, such as relieving pain, may be permissible even when a foreseen but unintended harmful effect, such as hastened death, might occur.

Deliberately stopping a treatment such as dialysis, mechanical ventilation, or vasopressors after deciding it no longer serves the patient's goals; it is generally considered ethically and legally permissible.

Suffering that arises when illness threatens a person's sense of meaning, purpose, connection, or relationship with a higher power, often shown as anger, guilt, hopelessness, or isolation.

An ongoing stance of openness and self-reflection in which clinicians recognize their own biases and learn from each patient's culture instead of assuming they already understand it.

A person's sense of what is possible and worth living for; in serious illness it can be reframed toward realistic goals such as comfort, connection, and legacy without being taken away.

Grief felt before an expected death, including sadness, anger, and role changes; it can coexist with caregiving and may soften some of the shock after the death.

Disabling grief that stays intense and interferes with functioning for more than a year after a death, or about six months for children, and is recognized as a distinct diagnosis.

Grief that society does not openly recognize or support, such as after a miscarriage, an overdose death, or the loss of a partner whose relationship was not openly acknowledged.

The final phase of life, usually days to hours, marked by declining consciousness, little intake, changing breathing patterns, cool or mottled skin, and other signs that death is near.

The gurgling or rattling sound made when saliva and secretions pool in the throat of a dying patient who can no longer swallow or clear them; it is usually not distressing to the patient.

A breathing pattern of gradually deepening then shallowing breaths followed by pauses, common as death approaches and often alarming to families even though the patient is usually unaware.

The use of sedating medication to relieve severe, refractory symptoms near the end of life, with comfort as the goal; it is not intended to hasten death.

Team-based care for people with serious illness that relieves symptoms and aligns treatment with what matters to the patient, given alongside curative or life-prolonging treatment from the time of diagnosis.

The discomfort felt when a clinician knows the right action to take but is blocked by rules, resources, or hierarchy, which can contribute to burnout and to leaving a position.

The gradual emotional and physical exhaustion that can follow prolonged exposure to others' suffering and heavy caregiving demands, showing up as detachment, irritability, or reduced empathy.

A group of clinicians from different disciplines, such as medicine, nursing, social work, chaplaincy, pharmacy, and therapy, who share goals and coordinate care with the patient and family.