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PATCH MATCH* Home Palliative Care Challenge

PATCH MATCH* Home Palliative Care Challenge. December 2007 Deon Cox Hayley, DO Section of Geriatrics Department of Medicine University of Chicago. *Sponsored by a grant from the AETNA Foundation. PATCH (Palliative Access Through Care at Home). Geriatrics Home Palliative Care

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PATCH MATCH* Home Palliative Care Challenge

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  1. PATCH MATCH*Home Palliative Care Challenge December 2007 Deon Cox Hayley, DO Section of Geriatrics Department of Medicine University of Chicago *Sponsored by a grant from the AETNA Foundation

  2. PATCH (Palliative Access Through Care at Home) • Geriatrics Home Palliative Care • 50% end stage dementia • 33% other non-cancer dx • 16% cancer

  3. Round One Poppies No Place Like Home Remember This My Best Pall Down on the Pharm 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500

  4. Essential to address in patients on opioids.

  5. What is a bowel regimen? Morrison LJ, Morrison RS. Palliative Care and Pain Management. Med Clin North Am. 2006: 90 (5); p 988.

  6. The primary opioid brain receptor (especially responsible for respiratory depression).

  7. What is mu?

  8. Bonus question: What are the other two brain opioid receptors?

  9. Delta, Kappa

  10. Nausea and vomiting, drowsiness, dry mouth, miosis, itching, urinary retention and constipation.

  11. What are common side effects of opioids?

  12. A recurring compulsion to take medication despite harmful consequences to the individual's health, mental state or social life.

  13. What is addiction?

  14. The clearance of morphine

  15. What is renal?

  16. The number one reason cited for family members to “place” patients in nursing home.

  17. What is urinary incontinence?

  18. Patient has a skilled nursing need and is homebound.

  19. What are the criteria for a home health nurse covered by Medicare?

  20. Monitoring of vital signs or pulmonary/cardiac status, wound care, monitoring of symptoms or medication side effects, ostomy care, foley catheter or PEG tube care.

  21. What are skilled nursing needs?

  22. Housing with some degree of meal provision and medication management.

  23. What is assisted living?

  24. Subsidized apartments for those over age 65.

  25. What are Senior Buildings?

  26. Not recommended as behavior management for moderate to advanced dementia patients.

  27. What is re-orientation?

  28. A state of inattentiveness and altered level of consciousness.

  29. What is delirium?

  30. The primary cause of delirium.

  31. What are medications?

  32. The percentage of patients over age 85 who have dementia.

  33. What is > 40%?

  34. Is thought to be the fourth most common cause of death in the U.S.

  35. What is dementia?

  36. The 2 organ systems where 5HT3 (serotonin) receptors are located.

  37. What are brain and gastrointestinal system receptors?

  38. A normal, not pathological, life cycle event in people who are dying.Features include: rumination about the past, withdrawal from family/friends and periods of sadness, crying or anxiety.

  39. What is preparatory grief?

  40. Opioids that are safest in renal insufficiency

  41. What are fentanyl and methadone?

  42. Class of agents that may be very helpful for excess mucous production

  43. What are anticholinergics?

  44. Bonus question:What are some examples of meds?

  45. Scopolamine, Glycopyrollate, Atropine drops, Atrovent, Spiriva, Hyoscyamine

  46. Symptoms treated by pro-kinetics, antihistamines, antipsychotics, benzodiazepines, anticholinergics and serotonin receptor antagonists

  47. What are some examples of anti-emetics?

  48. Use of multiple medications--when too many forms of medication are present, more drugs are prescribed than clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ("pill burden").

  49. What is polypharmacy?

  50. Equally efficacious to dexamethasone as an appetite stimulant andsuperior to dronabinol in appetite stimulation and non-fluid weight gain.

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