A 87-year-old black female who is near death is receiving hospice care and has developed failure to thrive. She refuses to eat and the family is concerned that she will starve to death.
Which one of the following would be most appropriate?
Correct Answer E:
Families and professional caregivers often interpret cessation of eating as starving to death. Loss of appetite is part of the dying process and most dying patients who stop eating are not hungry. Parenteral or enteral feeding at the end of life does not improve symptoms control or lengthen life.
Which one of the following statements regarding palliative care services is most consistent with the National Consensus Project for Quality Palliative Care guidelines?
Correct Answer C:
Palliative care services are provided to patients of all ages who have a chronic illness, condition, or injury that adversely affects daily functioning or reduces life expectancy. Ideally, palliative care begins when a condition is diagnosed and continues through cure or until death and family bereavement. The unit of care comprises the patient and his or her family as defined by the patient or surrogate.
The care plan changes according to the evolving needs and preferences of the patient and the family, and may involve additional input from other specialists and caregivers. The care team should help patients and families understand any changes that occur in the condition and how they affect ongoing care and goals of treatment. The evolving care plan should be documented clearly throughout, including alternative options for settings and treatment, and should be conveyed to all involved.
The management of pain should incorporate pharmacologic, nonpharmacologic, and complementary therapies. Barriers to effective pain management, such as fear of side effects, addiction, or respiratory depression, should be recognized and addressed. Because controlled substances are often used for long-term symptom management, palliative care professionals need to work with policy makers, law enforcement representatives, and regulators to ensure that efforts to address drug abuse do not interfere with the care of patients who are in pain.
You are caring for a 70-year-old male with widespread metastatic prostate cancer. Surgery, radiation, and hormonal therapy have failed to stop the cancer, and the goal of his care is now symptom relief. He is being cared for through a local hospice. Over the past few days he has been experiencing respiratory distress. His oxygen saturation is 94% on room air and his lungs are clear to auscultation. His respiratory rate is 16/min.
Which one of the following would be best at this point?
Correct Answer A:
Dyspnea is a frequent and distressing symptom in terminally ill patients. In the absence of hypoxia, oxygen is not likely to be helpful. Opiates are the mainstay of symptomatic treatment.
Haemophilus influenzae Type B vaccine has been recommended for which one of the following groups?
Hib disease is preventable by immunizing all children under age 5 years with an approved Hib vaccine. Several Hib vaccines are available. The general recommendation is to immunize children with a first dose at 2 months of age and to follow with additional doses based on the schedule for the vaccine being used. If a child under age 5 has missed getting immunized, a health-care provider can give details on the required vaccine dosage and schedule.
All of the following are live attenuated vaccines, except:
Vaccines which contain tiny amounts of live cells of a particular disease are considered live vaccines. In healthy people, this is just enough to give them protection against infection. But these vaccines can be dangerous in people that are immunocompromised and they should not have them, unless under specialist supervision.
Live vaccines are those given for measles, mumps and rubella (MMR), TB (BCG vaccine), yellow fever, and the oral typhoid vaccine.
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