1. End of Life Care Flashcards
What are the goals of end of life care
Always to comfort the patient
Often relieve pain
Can cure ailments also if appropriate
What are prognostic indicators in those close to death?
Speed of deterioration Weakness Dyspnoea Cachexia (extreme muscle wasting and weight loss) Reduced oral intake Drowsiness, cognitive impairment Deteriorating performance status (PPS) Deteriorating blood tests
What causes patients to die sooner than usual?
Infection
Pulmonary embolism
Massive bleed
heart attack
Stroke
electrolyte disturbance
Bowel obstruction
Why would a syringe pump be used in a hospital?
Patients don’t have a viable oral route
Patients have poor absorption
Patients are dying and unable to take tablets
What are some reversible causes of deterioration?
Hypercalcaemia
Infection
Dehydration
Opioid toxicity
Delirium
Steroid withdrawal
What are the 5 symptoms prescribed for at the end of life?
Secretions
Pain
Agitation/distress
Nausea
Breathlessness
What further things should be considered about a person at the end of their life?
Regular, planned review and documentation of a care plan
Food and drink
Comfort care
Assisted hydration or nutrition
Other
What medications are essential for those at the end of their life?
Hyoscine butylbromide (bucapan)- for secretions
Morphine/opiod
Midazolam
Levomepromazine
What is involved in your assessment of nausea and vomiting?
History-triggers, bowel habit, meds, does vomiting help?
Examination- general review for dehydration, sepsis and drug toxicity, CNS findings and abdo examination
Blood investigations- U&Es, LFT’s, Ca, Glu
Urine dip- infection
What are the five cases of nausea and vomiting?
Clinical toxicity/biochemical upset
Motility disorders
Intracranial disorder
Chemo/radiotherapy induced
Multifacotiral/unknown
How do you treat clinical toxicity induced vomiting?
Treat metabolic imbalances (fluids, bisphosponates)
Antiemetic :dopamine antagonist- metoclopramide, domperidone, haloperidol
How is vomiting caused by motility disorders treated?
Antiemetic, prokinetic- metoclopermaide (unless complete obstruction)
Extrinsic try steroid e.g. dexmethasone
Give laxitives if constipated
Intracranial disorders can lead to vomiting. How would this be treated?
Antiemetic, antihistamine/anticholinergic e.g. cyclizine
Steroid (dexamethasone)
How would one treat nausea and vomiting from a higher centre?
Broad spectrum anti-emetic (levomepromazine)
Consider steroids
Consider higher centre origin (pain, fear, anxiety give benzos and non pharmacological management)
What is the non-pharmacological management of nausea and vomiting
Regular small portions
calm environment
correct the correctable
look out for thrush
psychological approaches
