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Biomedical subjects

R L Fainsinger

Publications and source records attributed to R L Fainsinger.

49 records · Page 3Linked to original sources
PubMed1993

A perspective on the management of delirium in terminally ill patients on a palliative care unit.

This article outlines the approach to the management of delirium developed by the staff of the palliative care unit at the Edmonton General Hospital. Delirium occurs commonly in the terminally ill and is associated with a poor prognosis. Management requires a clear understanding of what delirium is, how to assess it, investigations for reversible causes, and the medical treatments that are most useful. If not well managed, delirium can be a very distressing symptom for the patient and family as well as having a very destructive impact on the functioning of a palliative care unit.

Antipsychotic Agents↗
PubMed1992

The assessment of pain intensity in patients with cognitive failure: a preliminary report.

We reviewed our experience with 14 consecutive patients with cancer pain who developed severe cognitive failure that reverted either spontaneously or after specific treatment. In 3 patients who developed a nonagitated cognitive failure episode (CFE), there was no difference in the pain intensity measured by the patient before and after the episode and that measured by the nurse during the episode. In 11 patients who developed an agitated CFE, pain intensity assessed by a nurse during the CFE was significantly higher than the patient's assessment, both before and after the CFE. Patients who developed agitated CFE received a mean of 5 +/- 2 extra doses of narcotics per day, versus a mean of 2.17 +/- 1.6 doses in the average patient in our unit (P less than 0.01). Upon complete recovery, none of the 14 patients recalled having had any discomfort during the CFE. Problematic conflict between staff and family was detected in 4 of 11 cases of agitated CFE (36%), versus an expected 13 of 260 cases (5%, P less than 0.01). We conclude that (a) patients who recover from a severe CFE have no memory of pain; (b) medical and nursing staff are likely to overestimate the level of pain of patients with agitated CFE; and (c) agitated CFE in patients with cancer pain is a major source of distress for the patients' families and staff.

Cognition Disorders↗
PubMed1992

The use of urinary catheters in terminally ill cancer patients.

Recent reports have commented on the need to improve our knowledge and management of urinary problems in terminally ill patients. We conducted a prospective study in 61 consecutive patients admitted to our palliative care unit (PCU), who were assessed for urinary problems, use of urinary catheters, and management of problems associated with the catheters. A total of 74% (45 of 61) of the patients required a catheter before death, with 23 (38%) being admitted to the PCU with a catheter, and 22 patients (36%) requiring a catheter during admission to PCU. We present our findings regarding the duration of catheter use, indications for catheters, type of catheters used, and complications of catheters. The data collected suggest that, although urinary problems and catheter use are common in terminal illness, if strict guidelines are followed there is no demonstrable mortality, and morbidity associated with catheter use is outweighed by patient benefit.

Aged↗
PubMed1991

Hypodermoclysis (HDC) for symptom control vs. the Edmonton Injector (EI).

Hypodermoclysis (HDC) is a well-known method of providing symptom control in terminally ill patients. In this article we make reference to two previous reports describing our use of HDC and a new method of subcutaneous narcotic delivery called the Edmonton Injector (EI). The rationale for using HDC mainly for rehydration and the EI when subcutaneous narcotics are needed is explored. The controversy surrounding the treatment of dehydration in the terminally ill is examined. Finally, the advantages on our palliative care unit of the convenience, increased flexibility, and cost and time saving of these two treatment methods are discussed.

Cost-Benefit Analysis↗