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Continuous Subcutaneous Infusion: An Effective, Cost-Effective Analgesia Alternative at the End of Life

Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional: March 2009 - Volume 27 - Issue 3 - p 148–149
doi: 10.1097/01.NHH.0000347678.23241.51
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CE TEST QUESTIONS

GENERAL PURPOSE

To explore for registered professional nurses the use of continuous subcutaneous infusion as a means of pain management for patients at the end of life.

LEARNING OBJECTIVES

After reading this article and taking this test, you should be able to:

  1. Discuss key information about symptom management at the end of life.
  2. Outline the use of continuous subcutaneous infusion of analgesics.
  3. Plan the appropriate interventions for patients who are receiving continuous subcutaneous analgesic infusion.

1. According to the American Nurses Association, patients often do not fear death as much as the process of dying secondary to

a. effects of dehydration.

b. incapacitating fatigue.

c. persistent immobility.

d. uncontrolled pain.

2. Assigning no fault for an unintended outcome following a good intention is the basis of an ethical principle known as

a. common good.

b. double effect.

c. formal cooperation.

d. proportionate means.

3. For achieving optimal pain control, best practice recommends using the

a. least invasive route possible.

b. strongest analgesic tolerated.

c. most adjuvants appropriate.

d. lowest effective dosages.

4. At the end of life, the second route of choice is

a. oral.

b. intravenous.

c. rectal.

d. subcutaneous.

5. The most commonly prescribed medication for cancer pain is

a. hydrocodone.

b. morphine.

c. ketorolac.

d. fentanyl.

6. The opioid of choice when higher doses are required for continuous subcutaneous infusion (CSI) is

a. hydromorphone.

b. morphine.

c. ketorolac.

d. fentanyl.

7. Continuous infusions have an advantage over intermittent injections as they prevent a bolus effect that tends to cause

a. anxiety.

b. headache.

c. nausea.

d. diarrhea.

8. One of the two major determinants of how fast subcutaneous drug absorption takes place is

a. drug stability.

b. blood flow.

c. coadministration of other drugs.

d. the condition of the liver.

9. Comparing oral with subcutaneous administration of morphine, Kalso and colleagues identified fewer episodes of which of the following with subcutaneous dosing?

a. dysuria

b. tinnitus

c. dizziness

d. nightmares

10. Centeno and colleagues report a higher incidence of skin irritation with which of the following analgesics?

a. oxycodone

b. methadone

c. ketorolac

d. fentanyl

11. Which of the following is considered an inappropriate subcutaneous injection site?

a. deltoid

b. thigh

c. abdomen

d. subclavicular

12. A recommended skin cleansing solution to use prior to subcutaneous insertion of a needle or catheter is

a. alcohol.

b. chlorhexidine.

c. sodium chloride.

d. hydrogen peroxide.

13. Subcutaneous sites are typically rotated every

a. 1 to 2 days.

b. 2 to 3 days.

c. 3 to 5 days.

d. 5 to 7 days.

14. Coyle reports good tolerance of subcutaneous infusion rates of

a. 3 to 5 mL/hour.

b. 5 to 6 mL/hour.

c. 6 to 8 mL/hour.

d. 8 to 9 mL/hour.

15. Which of the following is recommended if aspiration after subcutaneous catheter insertion yields a blood return?

a. Remove the catheter and reinsert it.

b. Advance it further and recheck for aspiration.

c. Secure the catheter in position.

d. Withdraw it slightly and recheck for aspiration.

16. According to Anderson and colleagues, the recommended angle of insertion for a subcutaneous catheter or needle is

a. 15 to 20 degrees.

b. 30 degrees.

c. 45 to 60 degrees.

d. 90 degrees.

17. It is recommended that patients and caregivers assess the subcutaneous infusion site

a. one a day.

b. twice a day.

c. every 8 hours.

d. every 4 hours.

18. Compared with intravenous (IV) doses of opioids, CSI doses are

a. equianalgesic.

b. twice that of IV doses.

c. three quarters of IV doses.

d. half that of IV doses.

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© 2009 Lippincott Williams & Wilkins, Inc.