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Medically Challenging Cases: Complex gut function; self-administration by oral, rectal, PEG, and ostomy routes

1 hour 5 minutes

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2023 Conference Session
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To receive Continuing Education units and certificate,
use quizzes and $20 payment form below

Verification & Certification

If you would like to receive 1 unit of CME/CE credit for this session, please progress from the Pre-test Quiz below, to the Video, to the Post-test quiz after completing the video.

Name*
First Last
Degree*
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Date*
MM slash DD slash YYYY
For a patient with a bowel obstruction at the level of the mid transverse colon, the clinician should:*
- Continue with oral administration because the medications are absorbed in the duodenum, so the distal bowel obstruction should have little effect.
- Control nausea and vomiting with a venting gastric tube, and then use the oral route by briefly turning off the suction of the venting tube.
- Give high-dose dexamethasone on the morning of aid in dying to decrease bowel swelling, then proceed with oral self-administration.
- Recommend rectal self-administration of aid-in-dying medications.
In evaluating the rectum for administration of aid in dying medications in a patient with ovarian cancer treated with surgery two years prior to aid in dying, all of the below are essential except:*
- Reviewing surgical notes if they can be obtained.
- Reviewing available abdominal scans.
- Placing pyridium in the rectum and checking for orange urine, to be sure the rectal mucosa has the ability to absorb medications.
- Doing a digital rectal examination.
For an ALS patient, all of the above can be used for self-administration into a PEG tube, except:*
- The patient can push a catheter-tip syringe plunger with his forehead while someone stabilizes the body of the syringe.
- Any person can set up a gravity bag, add in the aid-in-dying medications, and the patient can release a clamp to start the flow.
- Any person can set up a gravity bag, and if the gravity-pressure isn’t enough for the medicines to drain into the PEG tube, an assistant can squeeze the bag so the medicines can flow.
- Using a suspended gravity bag containing the aid-in-dying medications, the patient can be given a kinked part of the tubing in her mouth, and start the medications by releasing the kinked section, which unfolds spontaneously and starts the flow.
When the powdered suspension of aid-in-dying medications are in a 60cc catheter-tip syringe, gradual pressure is recommended because if the patient pushes as hard as she can to rapidly administer the medications, the result may be:*
- Sudden opening of the connection from the syringe, with spraying of the medications into the room.
- Faster flow, but the patient will fatigue more quickly and may not finish the dose.
- Faster flow, so the patient loses consciousness so rapidly she can’t complete the total dose
- Faster flow, and that will facilitate the effect of the medications.

You must answer 3 of 4 questions correctly to receive credit. Refresh this page if you need to retake the test. Do not hit “submit” unless you have answered 3 of 4 questions correctly.

Name*
First Last
Degree*
Email*
Date*
MM slash DD slash YYYY
For a patient with a bowel obstruction at the level of the mid transverse colon, the clinician should:*
- Continue with oral administration because the medications are absorbed in the duodenum, so the distal bowel obstruction should have little effect.
- Control nausea and vomiting with a venting gastric tube, and then use the oral route by briefly turning off the suction of the venting tube.
- Give high-dose dexamethasone on the morning of aid in dying to decrease bowel swelling, then proceed with oral self-administration.
- Recommend rectal self-administration of aid-in-dying medications.
In evaluating the rectum for administration of aid in dying medications in a patient with ovarian cancer treated with surgery two years prior to aid in dying, all of the below are essential except:*
- Reviewing surgical notes if they can be obtained.
- Reviewing available abdominal scans.
- Placing pyridium in the rectum and checking for orange urine, to be sure the rectal mucosa has the ability to absorb medications.
- Doing a digital rectal examination.
For an ALS patient, all of the above can be used for self-administration into a PEG tube, except:*
- The patient can push a catheter-tip syringe plunger with his forehead while someone stabilizes the body of the syringe.
- Any person can set up a gravity bag, add in the aid-in-dying medications, and the patient can release a clamp to start the flow.
- Any person can set up a gravity bag, and if the gravity-pressure isn’t enough for the medicines to drain into the PEG tube, an assistant can squeeze the bag so the medicines can flow.
- Using a suspended gravity bag containing the aid-in-dying medications, the patient can be given a kinked part of the tubing in her mouth, and start the medications by releasing the kinked section, which unfolds spontaneously and starts the flow.
When the powdered suspension of aid-in-dying medications are in a 60cc catheter-tip syringe, gradual pressure is recommended because if the patient pushes as hard as she can to rapidly administer the medications, the result may be:*
- Sudden opening of the connection from the syringe, with spraying of the medications into the room.
- Faster flow, but the patient will fatigue more quickly and may not finish the dose.
- Faster flow, so the patient loses consciousness so rapidly she can’t complete the total dose
- Faster flow, and that will facilitate the effect of the medications.
Certification: I certify that I have spent at least 1 hour to watch this video and answer the pre- and post-test quizzes, for 1 unit of continuing education credit.*
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Please pay for your continuing education credit and certificate using the form below. 2023 Conference Sessions, and 2024 or 2025 education videos = $20. All other sessions = $15. Your certificate will be emailed within 2 weeks. Thank you!

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Teaching and supporting best practices for the care of patients considering or completing medical aid in dying.

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Medically Challenging Cases: Complex gut function; self-administration by oral, rectal, PEG, and ostomy routes

Verification & Certification

Pre-Test Quiz

Post-Test Quiz

Evaluation

Payment

Continuing Education Payment and Certificate

Contact Information

Payment Information

Teaching and supporting best practices for the care of patients considering or completing medical aid in dying.