Managing other symptoms Flashcards
Respiratory Alimentary Urinary Other
What are some causes of a cough in a palliative patient?
Infection Cancer or mets in lungs GORD Asthma Drug-induced cough
How can a cough be managed in a palliative patient?
Assess appropriateness of antibiotics if infective cause
3 different types of drugs
- Cough suppressants:
- codeine
- morphine
- methadone - Expectorants (encourage more productive cough)
- Sodium chloride nebs - Demulcents: soothing, protective film on mucus membrane
- Glycerol syrup
What 3 remedies are there to treat a cough in a palliative patient? How do they help and give examples?
Cough suppressants: Suppress cough - codeine - morphine - methadone
Expectorants:
- make cough more productive
- NaCl nebulisers followed by physio
Demulcents: soothes and protects mucus membrane
Glycerol syrup
What are some causes of SOB in palliative patients?
And how can we manage each type?
Airway obstruction (COPD, asthma)
- bronchodilators (salbutamol)
- INH or PO corticosteroids
- anti-cholinergics (ipatropium)
Malignancy
- Respiratory sedatives (morphine)
Heart failure
- Diuretics
- ACEi
- Digoxin
- Respiratory sedatives (morphine)
SVC
- Corticosteroids
- Chemo + radiotherapy
Anxiety
- benzodiazepines
Briefly describe what SVC obstruction is?
When a tumour presses on the SVC meaning blood builds up in the veins in the head
There’s SOB, dysphagia, stridor
You can treat SOB using respiratory sedatives. What are these and how do they work?
Opioids
Not fully understood how it works
Opioids reduce ventilatory response to hypercapnia, hypoxia and increased HR
This reduces respiratory effort and thus reduces dyspnoea
How do benzodiazepines help in SOB?
Reduces the perception of breathlessness and reduces anxiety which could be raising resp rate
Why do palliative patients get bleeding problems?
Thrombocytopenia Vit K deficiency Heparin-induced thrombocytopenia Hepatic or renal impairment Tumour eroding intp blood vessel Lung cancer causing haemoptysis
If you have a palliative patient with moderate bleeding problems, what should you do?
Correct correctable
Stop blood thinners: aspirin, heparin, warfarin
Treat with:
- transexamic acid
- radiotherapy if it is haemoptysis
- treat any bleeding wounds
How would you treat a palliative patient with major bleeding?
Why might a major bleed occur?
In many cases, no treatment is necessary if this happens. Just make them comfortable and get family nearby. Death often occurs within minutes.
If the tumour erodes a blood vessel