Key things to remember for PH4118

Question 1

What are the 6 values on a NEWS chart

Answer 1

respirations
oxygen saturation
blood pressure
pulse
consciousness
temperature

Question 2

what is the normal rate for respiratory

Answer 2

12-20 breaths per minute

Question 3

Level of Conciousness assessment

Answer 3

• Alert: the patient is fully alert with spontaneous eye-opening
• Confusion (new): the patient is alert, but confused or disorientated
• Voice: the patient responds to a verbal stimulus.
• Pain: the patient responds to a pain stimulus only.
• Unresponsive: no response to voice or pain stimulus.

Question 4

anaphylaxis symptoms

Answer 4

air way problems
breathing problems
itching
swelling

Question 5

What advantage does the use of a syringe driver offer over other routes of administration for symptom control in end of life care? (3 marks)

Answer 5

Less invasive that intravenous administration
Less painful and more predictable than intramuscular administration
Allows quicker dose titration than transdermal administration

Question 6

LFTs are requested for two primary reasons:

Answer 6

· To confirm a clinical suspicion of potential liver injury or disease.
· To distinguish between hepatocellular injury (hepatic jaundice) and cholestasis (post-hepatic or obstructive jaundice).

Question 7

When would fentanyl patches be inappropriate?

Answer 7

They are not suitable in acute pain or when patients’ analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose.
Therefore, probably not suitable in this situation/patient

Question 8

How is neuropathic pain described?

Answer 8

Usually described as a tingling or burning sensation may be accompanied by a loss of sensation.

Question 9

What advantages would Diamorphine offer over Morphine, why would the palliative care team recommend this change?

Answer 9

Diamorphine is much more soluble drug when compare to morphine (1mark)

Allows for higher dose of opioids to be administered via a syringe driver while still maintaining the stability of the solution, important consideration for patients requiring very high dose of morphine. (1mark)
This will also improve compatibility of the driver solution if other treatments need to be added. (1mark)

Additional consideration, large doses of breakthrough pain relief can be administered in small volumes rather than giving repeated doses of subcut morphine (subcut prn doses are usually restricted in volume to 1ml max concentration of morphine 30mg/ml) (1mark)