All About Nursing · CNE review · Hospice & Palliative Care

Atopic Dermatitis near the end of life

Atopic dermatitis:

  • An extremely common skin disorder described as superficial inflammatory, erythematous, pruritic, and eruptive
  • In adults, it is usually localized and chronic
  • It is in many ways a cyclic disorder, starting as a constant pruritis causing scratching, which in turns causes a rash that causes of atopic dermatitis are unclear, although there is often intolerance to environmental irritants’.
  • Exacerbation of atopic dermatitis may be caused by conditions that are common to patients near the end of life, including emotional stress, temperature changes, and bacterial skin infections, and for this reason it is important to consider these factors as a potential etiology of dermatitis in these patients.
  • Therapy involves
    • avoidance of rubbing on the skin, minimization of scratching, and decreasing exposure to triggering stimuli in the environment.
    • The skin should be kept well lubricated
    • Medications that are useful in reducing symptoms are similar to those used for pruritis and include hydroxyzine, diphenhydramine, and topical steroids. If lesions are resistant to this therapy then superimposed infection may be present.
    • For such patients, antibiotic treatment directed against S. aureus may be of benefit.

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Anxiety, Depression, Caregiver Burnout, Grief, Anger, Frustration in End of Life Care

Anxiety

  • According to the DSM-5, anxiety disorders are those that share features of excessive anxiety and fear with related behavioral disturbances.
  • These disorders differ from normal fear and anxiety in their being excessive and persisting beyond developmentally appropriate periods, typically lasting 6 months or more
  • Types of anxiety:
    1. Separation anxiety – anxiety or fear about separation from an attachment figure
    2. Selective mutism- consistent failure to speak in social situations
    3. Social anxiety – fear or anxiety about social interactions or situations
    4. Panic disorder -recurrent panic attacks
    5. Phobias- fear of a specific object or situation
    6. Generalized anxiety disorder- persistent or excessive anxiety and worry about various domains.
  • Treatment:
    • Nonpharmacological interventions
      1. Establish a trusting relationship
      2. Be aware of any anxiety that you as a nurse may have that may be picked up on
      3. Do not leave a person experiencing an anxiety disorder exacerbation alone
      4. Maintain a calm, nonthreatening, manner-of-fact approach
      5. Keep stimuli minimized
      6. Use simple words and brief messages that are calmly and clearly explained
      7. Discuss the reality of the situation
      8. Include person on decision-making to feel more in control
      9. Encourage exploration of underlying feelings that contribute to irrational fears
      10. Teach and reinforce stress management /relaxation techniques
    • Pharmacological interventions
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All About Nursing · Hospice & Palliative Care

Dysphagia

Dysphagia is characterized by difficulty swallowing solids and /or liquids and may arise from a variety of underlying conditions, including cognitive impairment, weakness, mechanical obstruction, and incoordination. Presenting symptoms may include prolonged meal times, avoidance of certain foods/liquids, new head or body movements during meals, voice changes with eating, coughing, choking, or unexplained weight loss. Dysphagia place the patient at increased risk for aspiration and malnutrition.

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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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