Management of Delerium in Palliative Care

Question 1

Symptoms of opiod toxicity

Answer 1

Myoclonus 
Agitation 
Hallucinations 
Pseudohallucinations 
Altered consciousness 
Confusion 
Vivid dreams 
Hyperalgesia 
Whole body allodynia

Question 2

Later signs of opiod toxicity

Answer 2

Resp depression

Pin prick pupils

Question 3

Screening tools for delirium

Answer 3

The 4AT

Confusion Assessment Method (CAM)

Question 4

What is hyperalgesia?

Answer 4

Severe pain experienced from midly painful stimulus

Question 5

What are pseudohallucinations?

Answer 5

Disorders of perception that resolve when attention is brought to bear

Question 6

What is allodynia?

Answer 6

Pain experienced with non painful stimulus

Question 7

What organ does the majority of morphines metabolism to active metabolites take place?

Answer 7

Liver

Question 8

In which organ does the majority of the excretion of the active metabolites of morphine take place?

Answer 8

Kidneys

Question 9

Management of acute derlerium caused by another cause

Answer 9

Hydrate
Bloods to check for renal impairment
Reduce morphine dose
Do bloods to check for malignant hypercalcaemia
Sepsis screen
Explain diagnosis of opiod toxicity to the nurses
Empirical antibiotics to treat possible C diff infection

Question 10

How to manage pain when in opiod toxicity

Answer 10

Reduce morphine dose
Consider opiod switch 
Add non opiod analgesics 
Anaesthetic interventions 
Pre emptive analgesia (midazolam, fentanyl, Entonox)