5.3.2: FRAME 2- Analyze Cues

CORRECT Answer

Question Type: Matrix Multiple Choice

Scoring: 0/1

NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf

Hospice care includes an interdisciplinary team to provide supportive care services. The nurse recognizes Rhys requires additional comfort interventions.

What interventions can be implemented to assist in reducing Rhys’s current pain?

Intervention	Appropriate	Not Appropriate
Morphine	X
Music Therapy	X
Lorazepam		X
Range of Motion		X
Aroma Therapy	X
Spiritual Care	X
Fentanyl Patch	X
Massage	X

RATIONALE

Palliative and hospice care have been associated with improved patient symptom control and quality of life as well as increased satisfaction with care. Palliative care and hospice care provide different services and have different collaborative teams. It is important for nurses to understand the distinct differences between the two care services.

Palliative care aims to address the physical, psychological, and spiritual needs of clients living with serious illnesses with the goal of improving their quality of life (Shaley et al., 2018). Like palliative care, hospice provides comprehensive comfort care as well as support for the family, however, in hospice, attempts to cure the person's illness are stopped (National Institute on Aging, 2021). Managing pain for a client receiving palliative or hospice care can be challenging. Providing quality care requires effective pain assessment and implementing culturally congruent measures to manage the client’s pain. When nurses consider the clients cultural pain expression, values, beliefs, and experiences, not only do they improve the quality of care, but they are also better able to help the family adjust to the dying process (Gilver et al., 2023).

Despite the many documented benefits of palliative and hospice care, both types of care remain underutilized among client populations in need of these forms of care. Multiple factors contribute to the underutilization of palliative and hospice services such as an individuals’ lack of knowledge about these services and negative misperceptions can adversely affect individuals’ receptivity to these services (Shaley et al., 2018).

Clients with pancreatic cancer are best managed in a multidisciplinary team.

FOCUSED GUIDE

The Evaluation of pain at the end-of-life follows the general pattern of pain assessment aimed at the site of pain, the onset of pain, character, radiation of pain, exacerbating, and relieving factors. Verbal description of the quality of pain is an important marker of the origin of pain (Sinha et al., 2023). Pain scales can help standardize care and provide objective assessment tools that are not provider-dependent. Several pain grading scales have been developed with validation. However, none of these scales is proven to be superior to others. The Likert-type scale for pain grades pain on a scale of 0-10, with “10” being the worst pain imaginable and “0” representing no pain (Sinha et al., 2023).

Non-Pharmacological Management of Pain

The nonpharmacological measures for the management of pain include measures aimed at avoiding pain triggers and psychosocial assistance in managing the end-of-life. Proper head positioning and neck support can avoid spasms of the neck; artificial tears and lubricants can help avoid painful keratitis. The use of gel foam pads on the skin-appliance interface can help avoid ulceration, for example, nasal bridge gel pads for noninvasive ventilation. Oral care and proper hydration can avoid painful ulcerations and dental decay. Frequent repositioning and offloading of dependent areas of the body can help avoid decubitus ulcers. In case of skin breaks, non-bulky, non-stinging chemical dressings can be used to avoid pain.

Counseling for getting affairs in order and devising robust goals of care while the client can still make decisions may help alleviate anxiety and improve interpersonal relations. Daily sponging and grooming, as tolerated, leads to better hygiene, and preserves the client’s dignity and sense of self-worth. Spiritual counseling and pastoral visits can help counter non–acceptance of impending death and help alleviate suffering. Alternative medicinal therapies like acupuncture and Reiki can be offered to support pharmacological measures in managing pain (Sinha et al., 2023).

The difference between pharmacokinetics and pharmacodynamics is that pharmacokinetics is the movement of drugs through the body, whereas pharmacodynamics is the body’s biological response to drugs. Pharmacokinetics is what the body does to the drug and pharmacodynamics is what the drug does to the body.

Pharmacokinetics describes a drug’s absorption, distribution, metabolism, and excretion (ADME) properties and pharmacodynamics describes how biological processes in the body respond to or are impacted by a drug. While Pharmacokinetics describes a drug’s exposure by characterizing its ADME properties and bioavailability as a function of time, pharmacodynamics describes a drug’s response in terms of biochemical or molecular interactions. Pharmacokinetics and pharmacodynamics together can be thought of as an exposure/response relationship (Allucent, 2023).

What is the PPSv2? How is the PPSv2 interpreted?

Have the students review the PPSv2 tool and discuss client scenarios for each of the levels of care described on the tool. The tool is located at: https://micmtcares.org/sites/default...nce_Scale1.pdf to learn more about the PPSv2.