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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
Open-Access Resource
Free to View

(If you found this video useful, we welcome a Donation of $20
to help with our production expenses.)

If you would like to receive 1 unit of CME/CE credit and
a certificate for this session, please progress in the following order:
Pre-Test Quiz (below), Video (above), Post-Test Quiz (below); and
pay $20 using the form below.

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.
- control nausea and vomiting with a venting gastric tube and then use the oral route (briefly turn off suction).
- give high-dose dexamethasone the aid-in-dying morning to decrease bowel swelling followed by oral self-administration.
- recommend rectal self-administration of the aid-in-dying medications.
A patient with a history of ovarian cancer treated surgically two years prior to the aid-in-dying day is evaluated for rectal administration of the aid-in-dying medications. All of the below are essential except*
- reviewing surgical notes if they can be obtained.
- reviewing available abdominal scans.
- placing pyridium in the rectum to assess the mucosa’s ability to absorb medications.
- performing a digital rectal examination.
For an ALS patient, all of the below can be used for self-administration into a PEG tube except*
- patient using his forehead to push a syringe plunger with someone stabilizing the syringe.
- person sets up a gravity bag and adds the aid-in-dying medications; the patient releases the clamp to start the flow.
- person sets up a gravity bag and squeezes it if the gravity-pressure isn’t enough for the medicines to flow.
- person sets up gravity bag with the aid-in-dying medications, kinks the tubing, and places it into the patient’s mouth; patient decides when to unclamp and start the flow.
Gradual pressure is recommended when a powdered suspension of aid-in-dying medications is in a 60ml catheter-tip syringe because, if the patient pushes too hard, the result may be a*
- sudden opening of the connection from the syringe, with medications being sprayed into the room.
- faster flow but the patient will fatigue more quickly and may not finish the dose.
- faster flow with the patient quickly losing consciousness and the total dose not completely administered.
- faster flow which facilitates the effect of the aid-in-dying medications.

Please do not hit “Submit” until you have answered 3 of 4 questions correctly to receive credit (refresh this page to retake the test). If after clicking “Submit” you are still on the Course page, open the Post-Test Quiz and fill in the missing fields (*). After passing the Quiz, go to Evaluation, then Payment.

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.
- control nausea and vomiting with a venting gastric tube and then use the oral route (briefly turn off suction).
- give high-dose dexamethasone the aid-in-dying morning to decrease bowel swelling followed by oral self-administration.
- recommend rectal self-administration of the 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 to assess the mucosa’s ability to absorb medications.
- performing a digital rectal examination.
For an ALS patient, all of the below can be used for self-administration into a PEG tube except*
- patient using his forehead to push a syringe plunger with someone stabilizing the syringe.
- person sets up a gravity bag and adds the aid-in-dying medications; the patient releases the clamp to start the flow.
- person sets up a gravity bag and squeezes it if the gravity-pressure isn’t enough for the medicines to flow.
- person sets up gravity bag with the aid-in-dying medications, kinks the tubing, and places it into the patient’s mouth; patient decides when to unclamp and start 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 medications being sprayed into the room.
- faster flow but the patient will fatigue more quickly and may not finish the dose.
- faster flow with the patient quickly losing consciousness and the total dose not completely administered.
- faster flow which facilitates the effect of the aid-in-dying 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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