Palliative Care
Showing 15 of 15 topics
A
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Use structured conversations to complete POLST or similar medical orders reflecting code status, treatment intensity, and artificial nutrition preferences across settings.
C
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Use opioids with adjuvants such as corticosteroids and NSAIDs when appropriate; add bone targeted agents and consider palliative radiation or radionuclides for diffuse metastases.
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Use scheduled long acting or frequent short acting opioids with breakthrough doses at 10 to 15 percent of the total daily dose, reassessing frequently and managing side effects.
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Plan extubation for comfort by aligning goals, optimizing symptom control with opioids and anxiolytics, and preparing families for the process and expected changes.
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Prevent opioid induced constipation with scheduled osmotic plus stimulant agents, adequate fluids when appropriate, and rescue measures for impaction.
D
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Treat distressing breathlessness with low dose opioids, handheld fan or airflow to the face, positioning, and targeted oxygen only when hypoxemic.
H
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Discuss hospice when life expectancy is about six months or less if the illness runs its usual course; focus on comfort, support services, and avoidance of burdensome care.
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Treat symptomatic hypercalcemia with IV fluids, calcitonin for rapid effect, and a bisphosphonate or denosumab while aligning interventions to goals and prognosis.
M
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Use opioids and antiemetics, antisecretory therapy such as octreotide, corticosteroids for edema, and venting gastrostomy when goals are comfort focused.
N
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Use adjuvant agents for neuropathic pain with slow titration and monitoring for sedation and dizziness; combine with opioids only when needed.
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Explain cause to families, minimize fluid burden and suction only gently in the oropharynx, and use anticholinergics such as glycopyrrolate or scopolamine when secretions are distressing.
O
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Watch for myoclonus, hyperalgesia, hallucinations, or confusion; reduce dose, rotate opioid, hydrate if appropriate, and treat contributing factors.
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When switching opioids, calculate equianalgesic dose, reduce for incomplete cross tolerance by 25 to 50 percent, and retitrate to effect with close monitoring.
P
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For refractory symptoms at end of life, use proportionate sedation after interdisciplinary review and informed consent, with clear documentation of goals and monitoring.
T
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Identify reversible contributors, provide calm environment with family presence, and use haloperidol or alternative antipsychotics for distressing agitation after safety measures.
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