All About Nursing · Hospice & Palliative Care

Hypercalcemia at the End of Life

  • Hypercalcemia is associated with several cancers, most commonly breast, lung, lymphoma, and multiple myeloma. Hypercalcemia in the setting of advanced cancer may be caused by release of calcium due to bone metastases, solid tumor release of PTHrP (parathyroid hormone-related protein), or tumor production of calcitriol leading to increased intestinal calcium resorption. Hypercalcemia in cancer patients is indicative of widespread disease and is associated with a poor prognosis for long-term survival.
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All About Nursing · Hospice & Palliative Care

Pain Management at the End of Life (Reading and Sharing)

The prevalence of pain varies by dx, stage of disease, and setting of care. Approximately 1/3 of patients with cancer experience pain at the time of diagnosis, while 2/3 with metastatic disease report pain. Less is known about the prevalence of pain in those with diagnoses other than cancer.

Pain is described by the World Health Organization as a “multidimensional phenomenon with sensory, physiological, cognitive, affective, behavioral and spiritual components.” Pain is a complex biopsychosocial phenomenon, an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in these terms. (Pain is whatever the patient says it is.)

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CNE self study · Hospice & Palliative Care

What is POLST?

POLST is a physician order for life-sustaining treatment, which is called a medical order for life-sustaining treatment in some states. This form is created during a conversation with a medical provider and lays out the patient’s end-of-life wishes. It is considered a medical order, and is most useful in times of emergency. Typically, POLST or MOLST forms are intended for patients who have a life expectancy of 1 year or less, and the POLST is a doctor’s order for the specific instructions the patient has given the physician about what to do in possible future situations.

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All About Nursing · Hospice & Palliative Care

Pain Management: Addiction, Dependence, Pseudoaddiction, and Tolerance

Addiction: Compulsive use of a substance that occurs when it is used in a way other than intended. Patients have cravings when the substance is withdrawn, with an overriding inability to control their perceived need for the substance, even though there may be an awareness that the substance, or overuse of the substance, is harmful.

Dependence: A state in which the person feels that they can only function normally when using a specific substance. Abrupt withdrawal of the substance causes withdrawal symptoms.

Pseudoaddiction: The mistaken assumption that a patient who is seeking pain relief is addicted to a substance.

Tolerance: Occurs when the patient no longer has a therapeutic response to the drug and a higher dose is required to achieve the prior effectiveness.