Study Planning

20-27% Symptom Assessment and Management   15-22% Pain Assessment and Management 15-20% Last Days/Hours/Imminent Death Care  12-15% Care of the Person and Family  7-10% Interprofessional/Collaborative Practice  7-10% Education   5-8% Loss, Grief and Bereavement Support  5-8% Ethics and Legal Issues   5-8% Professional Development and Advocacy 

EXAM DATE: Sat APRIL 5, 2014REVIEW TIME START : Sat March 22, 201423 weeks til review time   138 days total til review time  minus 18 x 4 = 72 shift worked during 76 total to study until review time

BREAKDOWN OF % 165 QUESTIONS

BREAKDOWN OF %/# OF STUDY DAYS

Symptom (24%) = 18 Pain (18%) = 14 Last Days (17%) = 13 Person & Fam (12%) = 9 Interpro (7%) = 5 Edu (7%) = 5 Grief (5%) = 4 Ethics (5%) = 4 Pro devel & advo (5%) = 4

TIMELINE (START/END DATES)

Review during WORK days!!

SUNDAYS off from studying!

6 FLEX DAYS (by studying into Review period)

Symptom = Oct 12 - Nov 18 Pain = Nov 19 - Dec 16 Last Days = Dec 21 - Jan 11 Persons & Fam = Jan 17 - Feb 4 Interpro = Feb 5 - Feb 13 Edu = Feb 14 - Feb 24 Grief = Feb 25 - Mar 4 Ethics = Mar 5 - Mar 12 Pro devel & Advo = Mar 13 - Mar 21

Symptom Assessment and Management  18 DAYS -  Oct 12 - Nov 18

Professional Development and Advocacy 4 DAYS - Mar 13 - Mar 21

Pain Assessment and Management14 DAYS - Nov 19 - Dec 16

Last Days/Hours/Imminent Death Care 13 DAYS - Dec 21 - Jan 11

Care of the Person and Family 9 DAYS = Jan 17 - Feb 4

Inter professional/Collaborative Practice 5 DAYS - Feb 5 - Feb 13

Education  5 DAYS - Feb 14 - Feb 24

Loss, Grief and Bereavement Support 4 DAYS - Feb 25 - Mar 4

Ethics and Legal Issues  4 DAYS - Mar 5 - Mar 12

For each symptom look at: possible causes comprehensive assessment data ongoing assessment assessment tools interventions collaborative care planning Common medications used  special considerations for children, elderly, special needs (cognitively impaired, communication disorders, language barriers) impact on overall well-being

Symptoms - neuro  DAY 1  i) aphasia   ii) dysphasia  iii) extrapyramidal symptoms  iv) lethargy or sedation  v) paresthesia or neuropathies  vi) seizures

Emergencies/ Incidents: DAY 13- acute bowel obstruction; - cardiac tamponade;  - delirium;  - abnormal laboratory values (e.g., hypercalcemia, hyperkalemia);  - falls;  - hemorrhage;  - opioid or medication toxicity;  - pulmonary embolism and pleural effusion;  - respiratory depression/distress;  - seizures;  - spinal cord compression; and  - superior vena cava syndrome.

Common types of medications in EOL care : DAY 16 steroids, anticholinergics, prokinetics, neuroleptics, antidepressants, antipsychotics, chemotherapy pharmacological and physiological use potential side effects, interactions or complications, time trials medication administration techniques (breakthrough doses, routes, scheduling, titration, pumps) 

Non - pharm approaches : DAY 15 radiation therapy surgery physiotherapy rehabilitation therapy complementary therapies

Promoting personal/spiritual growth: DAY 17life review/legacy, reconciliation strategies, presence).

Non-cancer diagnoses: DAY 14 AIDS COPD ALS CHF

Symptoms - cognitive  DAY 2 i) agitation and terminal restlessness  ii) confusion  iii) delusions  iv) delirium  v) dementia  vi) hallucinations  vii) paranoia

Symptom -  cardiovascular:  DAY 3i) angina  ii) arrhythmia  iii) edema  iv) syncope

Symptom - respiratory:  DAY 4 i) congestion/excess secretions  ii) cough  iii) dyspnea  iv) apnea  v) hemoptysis  vi) hiccoughs

Symptom - GI: DAY 5i) nausea and vomiting  ii) constipation  iii) diarrhea  iv) bowel incontinence  v) bowel obstruction - partial obst vi) dysphagia  vii) jaundice

Symptom - nutrition and metabolic: DAY 6i) anorexia  ii) cachexia  iii) decreased intake of food/fluids  iv) dehydration  v) electrolyte imbalance

Symptom - GU:  DAY 7 i) bladder spasms  ii) urinary incontinence  iii) urinary retention

Symptom - immuno DAY 8i) medication reactions/interactions- allergic response- anaphylaxiii) infection- sepsis- pneumonia- herpes- stomatitis- candidiasis- urinary tract infection iii) pyrexia

Symptom - musculoskeletal: DAY 9i) pathological fractures  ii) weakness  iii) muscle spasm

Symptom - skin and mucous membranes:  DAY 10 i) candidiasis  ii) malignant wounds (e.g., fungating, fistulas)  iii) mucositis  iv) pressure areas  v) pruritus  vi) xerostomia

Symptom - psychosocial and spiritual: DAY 11i) anxiety  ii) anger  iii) denial  iv) * depression  v) fear  vi) guilt  vii) suicidal or homicidal ideation  viii) grief  vix) suffering  x) distress  xi) meaning and purpose of life and illness  xii) hope  xiii) forgiveness/acceptance  xiv) love and relatedness  xv) transcendence

Symptom - other: DAY 12   i) ascites  ii) fatigue/asthenia  iii) lymphedema  iv) myelosuppression (e.g., anemia, neutropenia, thrombocytopenia)  v) myoclonus  vi) sleep disturbances

Symptom Assessment and Management  18 DAYS -  Oct 12 - Nov 18

Emanuel, L., & Librach, S. (2011). Palliative care: Core skills and clinical competencies (2nd ed.). Philadelphia: Saunders.Ferrell, B. R., & Coyle, N. (Eds.). (2010). Oxford textbook of palliative nursing (3rd ed.). New York: Oxford University Press.Pereira, J. L. (2008). The pallium palliative pocketbook. Edmonton: The Pallium Project.Victoria Hospice Society. (2006). Medical care of the dying (4th ed.). Victoria, BC: Author.

Pain Assessment and Management14 DAYS - Nov 19 - Dec 16

Types of pain: DAY 4- Total pain- factors- phantom pain- incidental

Physiology of pain DAY 3- transduction;  - transmission; - modulation; - perception.

Classifications of pain DAY 1-2- acute;  - chronic;  - malignant;  - non-malignant;  - neuropathic; and  - nociceptive (somatic and visceral).

Comprehensive pain assessment DAY 5-7- possible causes- validated tools- initial and ongoing assessment- special considerations for elderly and children; special needs (cognitive impairments, communication disorders, language barriers)

Stepped approach to assessment & management: DAY 5-7 based on type & severity

Barriers to assessment & management (individual, family & HCP) DAY 5-7- myths- misconceptions- health-system barriers

Medication administration techniques : DAY 8-12- breakthrough doses- routes- scheduling- titration- pumps- *indications for opioid rotation- *equianalgesic conversions

Commonly used medications DAY 8 -12- potential side effects- interactions - complications.- antimigraine

Adjuvants DAY 13- pharmacological and physiological use- bisphosphonates- NSAIDS- corticosteroids,- anticonvulsants,- antidepressants,- antipsychotics- chemotherapy

Non-pharm interventions DAY 14- radiation therapy- surgery- physiotherapy- rehabilitation therapy- complimentary therapies

Exam Breakdown

Subject Breakdown

Symptom Assessment & Management

Bibliography

Pain Assessment & Management