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Résidence - FM Learner > 73. Palliative Care > Flashcards

73. Palliative Care Flashcards

1
Q

Describe : Principles of Palliative Care (9)

A
  • Affirms life and regards dying as a normal process
  • Neither hastens nor postpones death
  • Provides relief from pain and other distressing symptoms
  • Integrates the spiritual, cultural, psychosocial aspects of care
  • Ask patients about meaning of symptom/burden
  • Patient, family, caregivers are treated with dignity and respect
  • Patient, family, caregivers are supported in bereavement
  • Offers a support system to help patients live as actively as possible until death
  • Offers a support system to help patients’ families cope during the patient’s illness and in their own bereavement
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2
Q

Describe management of Massive Hemorrhage in palliative care

A
  • Anticipation (head and neck tumors - carotid, lung, GI, hematological)
  • Prepare the entourage
  • Major distress order (see below)
  • Cover with dark blankets/towels
  • Consider tranexamic acid
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3
Q

Describe management of dyspnea in palliative care (4)

A
  • Position (turn, sit up, elevate head of bed)
  • Air circulation (fan), oxygen PRN
  • Manage cough, secretions, anxiety (relaxation therapy)
  • Opioids (eg. morphine 1mg PO), benzodiazepines, bronchodilators
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4
Q

Describe management of pain in palliative care (4)

A
  • Total Pain (physical, psychological, social, spiritual)
  • Non-Pharmacological
  • Opioids (eg. morphine liquid or subcutaneously)
  • Adjuvant: Acetaminophen, NSAIDs, steroids, bisphophonates, cannabinoids
  • Interventional techniques (nerve block)
  • Frequent reassessments
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5
Q

Name : Risk factors for difficult pain control (6)

A
  • Rapid titration of opioids
  • Addiction or chemical coping
  • Psychiatric
  • Incidental
  • Delirium
  • Neuropathic pain (DN4)
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6
Q

Describe tx : Neuropathic pain

A
  • Gabapentinoids
  • TCA
  • SNRI
  • opioids
  • cannabinoids
  • methadone
  • Topical lidocaine, capsaicin
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7
Q

Name Non-Pharmacological management for pain (6)

A
  • Massage / Physical therapy
  • Pet therapy
  • Acupuncture
  • Relaxation / Hypnotherapy
  • Aromatherapy / Music therapy
  • Heat/Cold
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8
Q

Name side effets : Opoids (5)

A
  • constipation [no tolerance]
  • nausea
  • sedation
  • urinary retention
  • neurotoxicity
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9
Q

Describe Neurotoxicity of opioids

A

increased opioids, no improvement, hyperesthesia or hyperalgesia, tactile hallucinations, allodynia, myoclonus, seizures, delirium

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10
Q

Describe : Fentanyl patch

A
  • (Fentanyl transdermal = 200:1 morphine PO)
  • Half-dose if cover skin with tegaderm underneath (do not cut)
  • 12h before onset and 12h coverage after removal
  • Consider inhaled ICS sprayed on patch for irritation
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11
Q

Describe management of constipation in palliative care (5)

A
  • Scheduled toileting, sitting position
  • Exercise/mobility
  • Hydration
  • Laxatives : (1) Osmotic (PEG), (2) Stimulant (senna, bisacodyl), (3) Surfactant/Lubricating (docusate, glycerine suppository)
  • Warm water enema
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12
Q

Describe management of diarrhea in palliative care (3)

A
  • Rehydration, electrolyte correction
  • Hold laxatives
  • Consider psyllium, loperamide, opioid
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13
Q

Describe management of no-vo in palliative care (3)

A
  • Treat reversible causes
  • Non-pharmacological management
  • Pharmacological
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14
Q

Name reversable causes of no-vo (5)

A
  • Severe pain, Cough, Infection, Hypercalcemia, Tense ascites, Raised ICP, Anxiety
  • Drug-induced or metabolic
  • Constipation / Intestinal obstruction
  • Gastritis
  • Oral candidiasis
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15
Q

Describe tx of Drug-induced or metabolic no-vo (6)

A
  • Opioid rotation
  • Haloperidol
  • Metoclopramide
  • Cyclizine
  • Hyoscine hydrobromide
  • Ondansetron
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16
Q

Name Non-pharmacological management of no-vo ()

A
  • Cut out intolerant foods
  • Control malodour
  • Restrict intake (sips, ice chips, then gradually fluids to solids)
  • Small frequent meals
  • Cool fizzy drinks
  • Avoid lying flat after eating
  • Acupuncture/acupressure, ginger, relaxation, hypnosis, music therapy
17
Q

Name pharmacological management of no-vo (6)

A
  • Prokinetic (metoclopramide)
  • 5HT3 antagonists (ondansetron)
  • Antihistamine (dimenhydramine)
  • Anticholinergics (scopolamine)
  • Antipsychotics (Haloperidol 0.5mg SC q6-8h PRN, chlorpromazine, olanzapine)
  • Cannabinoids
18
Q

Describe management of Anorexia/Cachexia in palliative care (4)

A
  • Rule out contributing causes (N/V, anxiety, pain, stool)
  • Encourage favorite foods
  • Small frequent meals
  • Medical management:
19
Q

Describe MEDICAL management of Anorexia/Cachexia in palliative care (4)

A
  • Steroids (eg. dexamethasone 4mg PO BID at breakfast, and lunch), rapid onset but short-lasting (weeks)
  • Progesterone (megestrol acetate), slow-onset 2-3 weeks for effect
  • Prokinetic (metoclopramide) if early satiety
  • Mirtazapine
20
Q

Describe management of Asthenia/Fatigue in palliative care (4)

A
  • Coordinate activities/help
  • Change medications
  • Sleep
  • Medical management: Steroids. Methamphetamines
21
Q

Describe management of Noisy respiratory secretions
in palliative care (3)

A
  • Turn head to side
  • Avoid deep suctioning
  • Medical management : Glycopyrrolate, Scopolamine Atropine ophtalmic drops
22
Q

Describe management of Confusion/delirium
in palliative care (3)

A
  • Haloperidol PRN
  • Methotrimeprazine PRN
  • Midazolam PRN
23
Q

Describe management of DEPRESSION
in palliative care (3)

A
  • Psychotherapy
  • Methylphenidate in short-term
  • Consider SSRI if >4w
24
Q

Describe management of ANXIETY
in palliative care (2)

A
  • Hypnosis
  • Benzodiazepines (lorazepam 1mg SL/SC q6h PRN)
25
Q

Describe management of SOCIAL
in palliative care (3)

A
  • Guardianship
  • Wills
  • Finances
26
Q

Describe management of SPIRITUAL
in palliative care (3)

A
  • Personal values : “Are spirituality or religion important in your life?”, “Are you at peace?”
  • Relationships
  • Meaning of life/death : “Why me?”, “What’s after death?”
27
Q

Describe : Advance Care Planning and Goals of Care (7)

A
  • Breaking Bad News
  • Prognostication PPS
  • Hopes and Fears
  • Mandate
  • Goals of Care : Treatments, resuscitation (CPR, intubation, ICU), antibiotics, PEG/NG feeding, palliative sedation
  • Home vs. hospital vs. hospice
  • Medical Aid in Dying
28
Q

How to Prepare family for end of life (4)

A
  • Progressive unresponsiveness
  • Purposeless movements, facial expressions
  • Noisy breathing
  • Possible acute events and action plan (seizure, stroke)
29
Q

How to confirm and document Pronouncement of Death (7)

A
  • Check ID bracelet
  • No spontaneous respiration
  • No response to tactile stimulation and pain (pressure on nailbed)
  • Absent breath sounds, heart sounds
  • Absent carotid pulse
  • Fixed pupils, non-reactive to light
  • Time of death

Résidence - FM Learner (32 decks)

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