Each month, Enclara Pharmacia’s Clinical Management and Education teams come together to produce the Palliative Pearls Newsletter. This newsletter serves as an essential resource for hospice clinicians offering unique clinical case studies, clinical alerts, and industry news. Each clinical case study specializes in hospice and palliative care and is designed to be utilized as a self-study tool, a guide for discussion at interdisciplinary team meetings, or both! Ultimately, through our clinical case studies Palliative Pearls Newsletter we strive to help improve patient care by enhancing clinician’s knowledge.
In 2018, we highlighted a variety of different cases found to be especially important during hospice care. While every case from 2018 was educational, we put together a list of our top 5 most popular case studies from 2018 to revisit.
1. Dysphagia and Thickened Liquids
Dysphagia is a condition in which disruption of the swallowing process interferes with a patient’s ability to eat. It can result in aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction
Learn about the signs and symptoms of dysphagia, the management of the condition, and suggestions for liquid medication.
2. Ketamine for the Treatment of Refractory Pain
Ketamine is a, “rapid-acting general anesthetic producing an anesthetic state characterized by profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression”.
This case outlines which patients may benefit the most from Ketamine, routes of administration and highlights a pharmacist’s recommendation on dosing and duration.
3. Oxymetazoline (Afrin) Use for Nosebleeds
Oxymetazoline is a vasoconstrictor, and similar to epinephrine, may be used topically when applied to gauze or cotton swab to control bleeding.
Review suggestions for administering Oxymetazoline and review a pharmacist’s assessment on why it should be considered for nosebleeds during hospice.
4. Opioid-induced Constipation
Constipation significantly increases burden on severely ill patients, their family, and the health care system. Symptoms and complications from constipation include discomfort, pain, distress, nausea and vomiting, hemorrhoids, anal fissures, spurious diarrhea, and fecal impaction. Severe constipation and its complications also result in ER visits and hospitalizations and poor quality of life.
This case highlights a pharmacist’s recommendation on how to choose the best laxative and what to avoid when selecting your patient’s medication.
5. Rectal Administration and The Macy Catheter®
The Macy Catheter® is a prescription device to be placed by a clinician. Once in place, it can be used for repeat administration of liquid medications in solution or suspension form. The Macy Catheter® is comprised of a dual port, dual lumen ballooned tube that is inserted in the rectum just past the rectal sphincter, where the retention balloon is inflated to hold the device in place.
Review the indications for rectal route for drug administration, the pros and cons to The Macy Catheter® and a pharmacist’s assessment of the recommended hospice medications with literature supporting rectal absorption.
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