Palliative Care

Question 1

Seriously ill, hospitalized patients report that what things are worse than death?

Answer 1

• Incontinence
• Requiring a ventilator
• Persistent mental confusion

Question 2

Doctors are more likely to opt for dying at ____________.

Answer 2

home

Question 3

What proportion of medicare beneficiaries have the following in the last month of life?
•ED visit
• ICU admission
• Inpatient surgery

Answer 3

• ED: 1 in 2
• ICU: 1 in 3
• Inpatient surgery: 1 in 5

Question 4

What is the GAPS mnemonic?

Answer 4

• Goals at the end of life
• Advanced directive
• Psycho-spiritual support
• Symptom control

Question 5

What is necessary for hospice care?

Answer 5

A prognosis of six months or less

Note: palliative care does not require this. PC is primarily a symptom-management team for people with serious illness.

Question 6

Over the last thirty years, more people are dying in _____________ and fewer are dying in ____________.

Answer 6

their homes or in nursing homes; as inpatients

Question 7

List six things that dying people often want.

Answer 7

• A dedicated decision maker
• Financial life in order
• Knowing prognosis
• Knowing what physical changes to expect
• Pain control
• Maintain dignity

Question 8

How adept are doctors at recognizing the dying process?

Answer 8

• 49% can diagnose it in the last 24 hours

* 21% can diagnose it in the last 72 hours

Question 9

The cardiac system often goes from _________ to ___________ during the dying process.

Answer 9

tachycardic; bradycardic

Question 10

_____________ often need to be discontinued when dying people start struggling to breath.

Answer 10

IV fluids (which can worsen pulmonary edema)

Question 11

_____________ are often given to treat dyspnea. There is no evidence that this hastens death.

Answer 11

Opioids

Question 12

Three systems need to be checked to determine death: ________________.

Answer 12

• Neurologic: no cranial reflexes; nonresponsive
• Cardiac: no pulse
• Pulmonary: no respirations