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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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 Patients have cravings when the substance is withdrawn, with an overriding inability to control their perceived need for the substance, even though there may be an awareness that the substance, or overuse of the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.

All About Nursing · Hospice & Palliative Care

Determining Prognosis: Patients with Malignant Diseases (Reading & Sharing)

Cancer refers to a group of diseases that are characterized by genetic mutations in normal cells that cause them to become malignant. These genetic mutations involve the following:

      • Oncogenes, which are mutant genes that regulate cell proliferation. Oncogenes allow accelerated proliferation of the mutated cells, resulting in the rapid growth of cancerous tumors. 
      • tumor suppressor genes, which impede cell proliferation and suppress or prevent cell mutations. Cancer involves inactivation of tumor suppressor genes, allowing replication of mutated cells. 

In the TNM system: Cancer patients who require hospice or palliative care generally suffer from advanced disease, which is defined as metastatic spread of the malignancy from the primary site to other areas of the body and/or massive tumor growth at the primary site. The staging of tumors commonly follows the primary tumor, lymph node, and metastasis (TNM) system. 

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