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Behavioral Objectives -- Pain and Non-pain Symptom Management

Assessment and Treatment of Pain in the Terminally Ill

Behavioral Objectives

 Upon completion of the Junior Hospice/Palliative Care Rotation, the Junior student should be able to:

1. Recognize barriers to the practice of good pain management  
2. Describe several myths concerning morphine and opioid analgesics  
3. Distinguish between addiction, physical dependence and tolerance, as applied to opioid analgesics  
4. Perform a comprehensive assessment of physical pain in a terminally ill patient  
5. Distinguish between the symptoms and signs of acute pain and chronic pain
6. Describe interventions for mild, moderate or severe physical pain based on World Health Organization guidelines  
7. Differentiate between somatic, neuropathic, and visceral pain.
8. Describe the major opioid analgesics that are useful for treating severe chronic pain, their routes of administration, basic pharmacology/pharmacodynamics
9. List the major side effects of opioid analgesics, and counter measures to minimize these side effects
   • Describe appropriate treatments for nausea and constipation associated with opioid use
   • Describe four risk factors for respiratory depression in patients taking opioid analgesics
10. List several reasons why meperidine (Demerol^TM) is not suitable for the treatment of severe chronic pain
11. Calculate oral and intravenous equivalents of morphine, oxycodone and hydromorphone, and their equivalents to transdermal fentanyl
12. Describe an appropriate starting dose and titration scheme of opioid therapy for an opioid-naive patient with severe pain
13. Explain why round-the-clock dosing with opioid analgesics is preferred for the treatment of severe chronic pain such as that associated with terminal illness
14. List several long-acting or sustained-release opioid preparations;
    • Describe their basic pharmacokinetic properties;
    • Calculate appropriate maintenance therapy using these agents once initial analgesic titration has been done;
    • Calculate the appropriate dose and dose interval of immediate-acting opioid to be used on a PRN basis to control "Breakthrough" pain
15. Calculate a subcutaneous-infusion dose of morphine and hydromorphone
16. Describe the use of appropriate adjuvant drugs to treat bone pain, neuropathic pain visceral pain, and pain due to raised intracranial pressure

Management of Non-Pain Symptoms in the Terminally Ill

Behavioral Objectives

Upon completion of the Junior Hospice/Palliative Care Rotation, the Junior student should be able to:

1. Describe symptoms that are commonly experienced by patients in the terminal phase of an illness; 
2. Conduct a comprehensive assessment of the distressing non-pain symptoms associated with a terminally ill patient;
3. Prescribe effective medical or palliative treatments or interventions for symptoms such as fatigue, anorexia and dysphagia, dyspnea, nausea and vomiting, bowel obstruction, delirium and terminal restlessness, and other symptoms commonly manifested in patients at the end-of-life.

 

Required Readings:

The following two articles from American Family Physician by Drs. Ross and Alexander will assist you in the management of non-pain symptoms in patients at end-of-life. Both articles are succinct and well written. The articles can be downloaded and printed in PDF format at the following web site:

Ross, DD, Alexander, CS. Management of common symptoms in terminally ill patients. Part I: Fatigue, Anorexia, Cachexia, Nausea and Vomiting. American Family Physician 2001, 64:807-14. www.aafp.org/afp/20010901/807.html 

Ross, DD. Alexander, CS. Management of common symptoms in terminally ill patients. Part II: Constipation, Delirium, Dyspnea. American Family Physician 2001, 64:1019-26.www.aafp.org/afp/20010915/1019.html

 

 

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