Match each patient scenario involving advanced illness with the most appropriate next step in palliative symptom management, taking into account their underlying comorbidities.
- A 64-year-old hospice patient with end-stage renal disease and severe metastatic bone pain requires initiation of a continuous, long-acting opioid.Initiate a fentanyl transdermal patch or methadone; avoid morphine due to the risk of accumulating neurotoxic active metabolites.
- A 72-year-old actively dying patient with a known history of severe closed-angle glaucoma develops noisy, gurgling breathing (terminal secretions).Provide postural drainage by repositioning the patient laterally; avoid antimuscarinic agents to prevent precipitation of an acute ocular crisis.
- A 58-year-old with advanced ovarian cancer and a complete malignant small bowel obstruction has severe colicky abdominal pain and intractable vomiting.Discontinue prokinetic agents; initiate octreotide to reduce gastrointestinal secretions along with corticosteroids to decrease peritumoral edema.
- A 79-year-old actively dying patient with a long-standing history of Parkinson disease develops severe hyperactive delirium and aggressive behavior.Administer quetiapine or consider midazolam; avoid typical antipsychotics like haloperidol to prevent severe exacerbation of extrapyramidal symptoms.
Cevap
Match the ESRD patient to fentanyl/methadone, the glaucoma patient to repositioning (avoiding antimuscarinics), the complete bowel obstruction patient to octreotide/corticosteroids (avoiding prokinetics), and the Parkinson disease patient to quetiapine/midazolam (avoiding haloperidol).
Each correct match pairs an end-of-life symptom with the appropriate modified intervention that safely circumvents the patient's specific comorbidity-related contraindication.
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Anahtar Kavram
Advanced symptom management in palliative care requires careful modification of standard protocols based on patient-specific comorbidities that present absolute or relative contraindications.