Designed for easy use at the bedside, this manual contains the practical information health care professionals need to provide optimal end-of-life care. The book presents a multidimensional, holistic approach to assessment and management of the physical, psychological, social, and spiritual needs of the patient and family. Topics covered include cultural diversity in end-of-life care; communicating with patients and families; predicting life expectancy; terminal care; non-pain symptom management; pain control; palliative interventions; pediatric palliative care; record keeping; and ethics. The succinct, user-friendly presentation features bullet points and numerous quick-reference tables. Each chapter includes an "In a Nutshell" summary of key points.

The palliative care approach	p. 1
Definitions	p. 3
Philosophy - from "cure" to "comfort"	p. 5
The transition from "diagnose and treat" to "palliate"	p. 8
Historical perspective : what has changed?	p. 10
Cultural diversity in end-of-life care	p. 13
Planning for diverse populations	p. 15
African american culture and end of life	p. 18
Hispanic views on death and dying	p. 21
Understanding the Jewish culture	p. 24
Mourning in the Asian culture	p. 25
Death practices in the Muslim culture	p. 27
Building cultural bridges with other cultures	p. 28
Approach to the patient	p. 31
Delivering bad news	p. 33
The family conference	p. 36
Dealing with anger	p. 39
The spiritual assessment	p. 42
Giving realistic hope	p. 47
The DNR or AND discussion in seriously ill patients	p. 51
Advanced directives in health care	p. 54
Decision-making ability	p. 57
Goal setting	p. 60
The hospice conversation	p. 63
Telling the children	p. 67
What if a patient asked you to pray?	p. 70
Death pronouncement	p. 72
Completing the death certificate	p. 75
Informing significant others of a patient's death	p. 78
Writing a condolence letter	p. 81
Caring for the family	p. 83
Predicting life expectancy	p. 87
"How long do I have?"	p. 89
Guidelines for hospice	p. 91
Physician prediction of life expectancy	p. 93
Palliative performance score	p. 95
Specific diseases : noncancer diagnoses	p. 97
Delivery of palliative care	p. 105
The hospital palliative care unit	p. 107
Consulting in the hospital	p. 109
Hospice in delivery of palliative care	p. 113
Hospice in the nursing home	p. 115
Terminal care	p. 119
The syndrome of imminent death	p. 121
Near death awareness	p. 124
Terminal delirium	p. 127
Grief : uncomplicated vs. complicated	p. 130
Nonpain symptom management	p. 133
Tips for maximizing chances of success	p. 135
Dyspnea, air hunger, shortness of air	p. 137
Oral care basics	p. 140
Fever near the end of life	p. 142
Agitation and anxiety	p. 143
Sexual needs	p. 144
Spiritual and existential suffering	p. 145
Nausea and vomiting	p. 146
Dizziness	p. 149
Hiccups	p. 151
Fatigue	p. 153
Anorexia	p. 155
Constipation	p. 157
Delirium	p. 159
Diarrhea	p. 162
Incontinence	p. 164
Depression	p. 166
Nonhealing wounds	p. 167
Pruritus	p. 169
Insomnia	p. 171
Nightmares	p. 173
Pain control	p. 175
Myths about opioid use	p. 177
Legal liability of undertreating pain	p. 180
Principles of pain management	p. 183
Assessment of pain	p. 187
Converting one opioid to another (equianalgesic dosing)	p. 190
Opioid dose escalation	p. 195
Managing opioid side effects	p. 199
Opioid withdrawal	p. 202
Morphine	p. 204
Hydrocodone for pain	p. 208
Oxycodone for pain	p. 210
Methadone for pain control	p. 213
Gabapentin (Neurontin) for pain	p. 216
Naloxone (Narcan)	p. 219
Meperidine (Demerol) : not recommended for pain	p. 222
Propoxyphene (Darvon, Darvocet)	p. 224
Blocks	p. 226
Addiction vs. pain	p. 228
Pseudo-addiction	p. 232
Palliative interventions	p. 235
Tube feeding in palliative care	p. 237
Palliative chemotherapy	p. 240
Palliative radiation	p. 242
"Response rate" in cancer chemotherapy	p. 244
Ventilator withdrawal	p. 246
Bowel obstruction	p. 250
Treating the death rattle	p. 253
Aggressive wound treatment	p. 255
The palliative pediatric patient	p. 259
Children and death	p. 261
Neonatal population	p. 265
Pediatric intensive care unit	p. 268
Pediatric withdrawal of life support	p. 271
The dying adolescent	p. 274
Charting	p. 277
Documentation in palliative care	p. 279
Coding and billing for hospice/palliative care	p. 288
Ethics at the end of life	p. 293
Ethics and legal issues	p. 295
Hastened death : the rule of double effect	p. 297
When to stop - medical futility	p. 299
Caring for yourself and avoiding burnout	p. 301
Table of Contents provided by Blackwell. All Rights Reserved.

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A Practical Guide to Palliative Care

9780781763431

0781763436

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