CAQ-Palliative flashcards

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

Hospice eligibility prognosis

Prognosis of six months or less if the terminal illness runs its normal course, certified by two physicians; the patient elects the hospice benefit and forgoes curative treatment for the terminal diagnosis.

Palliative care definition

Interdisciplinary care focused on quality of life for patients with serious illness and their families, provided at any disease stage and alongside disease-directed treatment, not restricted to terminal illness.

Total pain

Concept describing pain as physical, psychological, social, and spiritual suffering combined; effective management requires assessing and addressing each component, not only nociception.

Equianalgesic dose

The dose of one opioid that produces analgesia equivalent to a dose of another; used to convert opioids safely, typically reducing the calculated dose by 25–50% for incomplete cross-tolerance.

Opioid tolerance

Need for increasing opioid dose to maintain analgesia; tolerance develops to analgesia, sedation, and nausea, but not to constipation or miosis, which persist.

Opioid-induced constipation

Constipation caused by opioid binding to peripheral mu receptors in the gut; tolerance does not develop, so a prophylactic bowel regimen is started when opioids are initiated.

Morphine-6-glucuronide

Active metabolite of morphine that accumulates in renal failure and can cause sedation and respiratory depression; use caution or choose an alternative opioid such as fentanyl in renal impairment.

Fentanyl transdermal patch

Long-acting opioid for opioid-tolerant patients only, generally those taking at least 60 mg oral morphine equivalents daily; not for acute pain or opioid-naive patients.

PAINAD scale

Observational pain tool for patients with advanced dementia who cannot self-report; scores breathing, negative vocalization, facial expression, body language, and consolability, each 0–2.

Dyspnea first-line treatment

Nonpharmacologic measures such as a cool fan, positioning, and oxygen if hypoxemic; low-dose opioids reduce air hunger, and benzodiazepines are second-line for anxiety-associated dyspnea.

Midazolam in palliative care

Short-acting benzodiazepine used for anxiety, dyspnea, and seizure; in the imminently dying it may be used for terminal agitation or refractory symptoms, with careful monitoring for sedation.

Terminal agitation

Restlessness and agitation in the last days of life; evaluate for reversible causes such as pain, urinary retention, constipation, or delirium, then treat with antipsychotics or benzodiazepines.

Delirium in palliative care

Acute fluctuating disturbance of attention and cognition; common in advanced illness, often multifactorial; identify and reverse causes and use antipsychotics cautiously for distressing symptoms.

Spiritual assessment

Evaluation of meaning, purpose, hope, and religious or existential concerns; tools include FICA (Faith, Importance, Community, Address) and HOPE (Hope, Organized religion, Personal spirituality, Effects).

FICA tool

Spiritual history mnemonic: Faith or belief, Importance or influence, Community, and Address in care; used to structure a brief spiritual assessment in clinical encounters.

Goals of care conversation

Discussion clarifying the patient's values, priorities, and acceptable outcomes to guide treatment decisions; documented and revisited as illness changes, often using a structured framework.

Advance care planning

Process of discussing and documenting future care preferences, including advance directives and health care proxy designation, before the patient loses decision-making capacity.

Health care proxy

Person designated to make medical decisions if the patient loses capacity; also called durable power of attorney for health care, activated only when the patient cannot decide.

POLST form

Portable medical order set (Physician Orders for Life-Sustaining Treatment) for seriously ill patients, documenting preferences for CPR, ventilation, and hospitalization; differs from an advance directive.

Withdrawal of life support

Removing interventions such as mechanical ventilation or dialysis after shared decision-making; premedicate for anticipated symptoms (dyspnea, pain, agitation) and provide ongoing comfort care.

Terminal extubation

Planned removal of an endotracheal tube in a dying patient; premedicate with opioids and benzodiazepines to prevent dyspnea and distress, and continue comfort-focused monitoring.

Imminent death signs

Findings in the last days: decreased oral intake, mottled extremities, Cheyne-Stokes breathing, terminal secretions, and altered consciousness; care focuses on comfort and family support.

Terminal secretions

Noisy breathing from secretions in the upper airway in dying patients; not usually distressing to the patient; reposition and use anticholinergics such as glycopyrrolate or scopolamine.

Grief versus depression

Grief includes waves of sadness and yearning with preserved self-esteem; depression includes persistent anhedonia, worthlessness, and functional impairment; distinguish to guide treatment.

Complicated grief

Persistent, intense grief impairing function beyond expected time frames; features yearning, avoidance, and identity disruption; may benefit from targeted psychotherapy.

Bereavement support

Care for family after death, including condolence contact, risk assessment for complicated grief, and referral to counseling or support groups; a required hospice service.

Hospice interdisciplinary team

Team including physician, nurse, social worker, chaplain, aide, and volunteers; develops and updates an individualized plan of care, with the patient and family as core members.

Hospice benefit periods

Two 90-day periods followed by unlimited 60-day periods; recertification required, and a face-to-face encounter before the third period and each subsequent period.

Continuous deep sedation

Use of sedatives to unconsciousness for refractory symptoms in the imminently dying, with informed consent; distinguished from euthanasia because intent is symptom relief, not hastening death.

Palliative chemotherapy

Chemotherapy given to relieve symptoms and improve quality of life rather than cure; goals and expected benefit are discussed, and discontinuation is considered when harm outweighs benefit.

Anorexia-cachexia syndrome

Metabolic wasting with appetite loss in advanced illness; appetite stimulants such as megestrol or corticosteroids may be tried short term, but feeding tubes rarely improve outcomes.

Malignant bowel obstruction

Bowel blockage from advanced cancer; management includes decompression, antiemetics (haloperidol, metoclopramide if incomplete), octreotide, and corticosteroids; surgery in selected cases.

Spinal cord compression

Oncologic emergency with back pain, weakness, and sensory loss; requires urgent MRI and corticosteroids (dexamethasone) plus oncology consultation to preserve neurologic function.