Palliative Practices : An Interdisciplinary Approach

by Kuebler, Davis & Moore

• ISBN13: 9780323028219
• ISBN10: 0323028217
• Edition: 1st
• Format: Paperback
• Copyright: 2005-02-23
• Publisher: Mosby

Summary

The first book of its kind, this must-have resource examines the integration of palliative interventions from a disease-specific approach, providing practical guidance on caring for patients who follow a progressive, chronic disease trajectory prior to death. This uniquely practical book addresses all aspects of palliative care, going beyond theoretical information to advise practitioners on the most effective management of common symptoms and providing physical, psychological, and spiritual comfort to patients and families. The multidisciplinary focus of care is reflected by collaborative contributors and diverse authorship of an oncology/palliative care nurse practitioner, a physician, and a social worker. Expert authors in the field of palliative care - an oncology/palliative care nurse practitioner, an MD, and a social worker - represent the collaborative nature of caring for chronically ill patients. The most common illnesses that cause death in the United States are addressed in separate chapters on specific disease states: Cardiovascular, Pulmonary, Nephrology, Oncology, and Neurology. Case studies at the conclusion of each chapter illustrate important patient scenarios in the context of clinical practice. Comprehensive drug information for symptom management and comfort measures is provided in an appendix, as well as palliative care assessment tools and helpful website resources. An entire chapter is devoted to cancer pain. Objectives at the beginning of each chapter introduce the reader to concepts that will be addressed in that chapter. Each chapter ends with multiple-choice objective questions to test the reader's comprehension, with answers and rationales provided in the back of book. Prognostic tables demonstrate precisely how and when to integrate palliative interventions into the course of an advanced illness, identifying prognostic indicators where appropriate. Other important topics are covered with chapters on sleep, ethics, cultural and spiritual issues, and the dying process.

Author Biography

Kim K. Kuebler, MN, RN, ANP-CS: Adult Nurse Practitioner, Primary/Oncology/Palliative Care, Private Practice Adjuvant Therapies, Inc., Atlanta, Georgia Mellar P. Davis, MD, FCCP: Director of Research, The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, Ohio Crystal Dea Moore, MA, MSW, PhD: Social Work Program Director, Assistant Professor of Social Work, Department of Sociology, Anthropology, and Social Work, Skidmore College, Saratoga Springs, New York

Table of Contents

UNIT I ISSUES SPECIFIC TO PALLIATIVE CARE	1	(118)
Palliative Care Perspectives	3	(26)
Barry M. Kinzbrunner
Introduction	3	(1)
Definitions	3	(4)
Hospice Care and the Medicare Hospice Benefit	7	(4)
Palliative Care Programs	11	(10)
The Future	21	(3)
Summary	24	(5)
Advance Care Planning	29	(20)
Crystal Dea Moore
Introduction	29	(1)
Advanced Illness Conversations	29	(1)
Strategies to Improve Communication Quality	30	(7)
Advance Care Planning	37	(4)
Personal Awareness and Self-Care	41	(4)
Summary	45	(4)
Evidence-Based Interventions	49	(14)
Dana N. Rutledge
Evolution of Evidence-Based Practice	49	(5)
Tools of Evidence-Based Practice	54	(1)
Implementing Evidence-Based Practice	55	(5)
Summary	60	(3)
Pharmacology	63	(20)
Mellar P. Davis
Introduction	63	(1)
Pharmacodynamics	64	(5)
Pharmacokinetics	69	(4)
Non-Linear Pharmacokinetics	73	(1)
Dosing Regiments in Pharmacokinetics	73	(1)
Importance of P-450 Enzyme System in Pharmaceutical Management	74	(1)
Ethnicity and Special Populations	75	(1)
P-450 Specific Enzymes	75	(1)
Metabolism Through Glucuronidation	76	(1)
Multiple Drug Transporters	77	(1)
Polypharmacy and Drug Interactions	77	(1)
Pharmacokinetics in Special Populations	78	(1)
Summary	79	(4)
The Interface Of Sleep	83	(36)
Kathy P. Parker
Introduction	83	(1)
Normal Sleep	83	(8)
Impaired Sleep and Sleep Disorders	91	(4)
Sleep in the Palliative Care Setting	95	(3)
Factors Associated With Impaired Sleep	98	(5)
Management of Impaired Sleep	103	(7)
Summary	110	(9)
UNIT II SPECIFIC DISEASE STATES AND SYMPTOM MANAGEMENT	119	(170)
Cardiovascular	121	(36)
Nancy M. Albert
Cardiovascular Disease	121	(2)
Pathophysiology of Advanced Heart Failure	123	(4)
Immune System Up-Regulation	127	(1)
Management of HF Symptoms	128	(4)
Prognostic Indicators for Palliative Interventions	132	(3)
Interventions Before Palliation	135	(13)
End-Of-Life Care	148	(2)
Summary	150	(7)
Pulmonary	157	(24)
James Varga
Joshua Cox
Introduction	157	(4)
Pulmonary Function Tests	161	(2)
Staging	163	(1)
Common and Frequent Symptoms	164	(3)
Dyspnea	167	(1)
Exacerbations	167	(1)
Monitoring	168	(2)
Pharmacologic Treatment	170	(4)
Nonpharmacologic Treatment	174	(1)
Pulmonary Rehabilitation	175	(1)
Anxiety and Depression	175	(1)
Summary	176	(5)
Nephrology	181	(16)
Michael Germain
Lewis M. Cohen
Introduction	181	(1)
Symptom Burden	181	(2)
Common Symptoms	183	(1)
Discussion of Specific Symptoms and Their Management	184	(6)
Advance Care Planning	190	(1)
End-Of-Life and Hospice Care	191	(1)
Discontinuing Dialysis	191	(1)
Future Research	192	(5)
Oncology	197	(50)
Mary Magee Gullatte
Roberta Kaplow
Debra E. Heidrich
Introduction	197	(1)
The Cost of Cancer	197	(2)
Culturally Competent Palliative Practices	199	(1)
Health Disparities	199	(1)
Cellular Pathophysiology of Advanced Cancer	200	(1)
Cancer Staging	201	(1)
Metastatic Sites and Associated Symptoms	202	(6)
Oncologic Emergencies	208	(1)
Hypercalcemia of Malignancy	209	(3)
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)	212	(2)
Increased Intracranial Pressure	214	(3)
Spinal Cord Compression	217	(3)
Superior Vena Cava Syndrome	220	(2)
Treatment-Related Oncologic Emergencies	222	(2)
Symptom Management in Advanced Malignancy	224	(13)
Summary	237	(10)
Cancer Pain	247	(22)
Mellar P. Davis
Jan L. Frandsen
Introduction	247	(1)
Pain Syndromes	248	(3)
Pain Assessment	251	(4)
Treatment	255	(8)
Summary	263	(6)
Neurology	269	(20)
Mellar P. Davis
Bushra I. Cheema
David Oliver
Pamela Sue Spencer
Amyotrophic Lateral Sclerosis	269	(10)
Huntington's Disease	279	(4)
Summary	283	(6)
UNIT III THE DYING PROCESS, GRIEF, AND BEREAVEMENT	289	(112)
Ethical Issues	291	(18)
Tom Tomlinson
Introduction	291	(1)
Ethical Issues in the Transition to Palliative Care	291	(7)
Ethical Issues Within Palliative Care	298	(6)
Summary	304	(5)
Cultural and Spiritual Issues	309	(26)
Diane B. Loseth
Crystal Dea Moore
John A. Mulder
Chad S. Peterson
Introduction	309	(1)
Cultural Impacts on Palliative Care	309	(13)
Spiritual Issues in Palliative Care	322	(7)
Summary	329	(6)
The Dying Process	335	(44)
Catherine Vena
Kim Kuebler
Sandra E. Schrader
Introduction	335	(1)
Dying in America	335	(1)
Theories on Death and Dying	336	(2)
Dimensions of Dying	338	(13)
Diagnosing Dying	351	(11)
Approaches to Care	362	(6)
Summary	368	(11)
Grief and Bereavement	379	(22)
Helen Kathleen Brophy McHale
Introduction	379	(1)
Death and Loss	380	(1)
Types of Grief	381	(4)
Stage Theories	385	(1)
Reactions to Grief	386	(1)
The Impact of Grief	386	(5)
Professional Responsibilities	391	(2)
Assistance	393	(3)
Summary	396	(5)
ANSWERS	401
APPENDIXES
A Medications by Disorder	418	(24)
Kim Kuebler
James Varga
Mellar P. Davis
B Medication Routes and Metabolism	442	(5)
Kim Kuebler
James Varga
Mellar P. Davis
C Palliative Care Assessment Tools	447	(24)
Marilyn O'Mallon
Kim Kuebler
D Websites	471
Kim Kuebler