Managing other symptoms Flashcards

Respiratory Alimentary Urinary Other

1
Q

What are some causes of a cough in a palliative patient?

A
Infection
Cancer or mets in lungs
GORD
Asthma
Drug-induced cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can a cough be managed in a palliative patient?

A

Assess appropriateness of antibiotics if infective cause

3 different types of drugs

  1. Cough suppressants:
    - codeine
    - morphine
    - methadone
  2. Expectorants (encourage more productive cough)
    - Sodium chloride nebs
  3. Demulcents: soothing, protective film on mucus membrane
    - Glycerol syrup
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What 3 remedies are there to treat a cough in a palliative patient? How do they help and give examples?

A
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some causes of SOB in palliative patients?

And how can we manage each type?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Briefly describe what SVC obstruction is?

A

When a tumour presses on the SVC meaning blood builds up in the veins in the head

There’s SOB, dysphagia, stridor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

You can treat SOB using respiratory sedatives. What are these and how do they work?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do benzodiazepines help in SOB?

A

Reduces the perception of breathlessness and reduces anxiety which could be raising resp rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do palliative patients get bleeding problems?

A
Thrombocytopenia
Vit K deficiency
Heparin-induced thrombocytopenia
Hepatic or renal impairment
Tumour eroding intp blood vessel
Lung cancer causing haemoptysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If you have a palliative patient with moderate bleeding problems, what should you do?

A

Correct correctable

Stop blood thinners: aspirin, heparin, warfarin

Treat with:

  • transexamic acid
  • radiotherapy if it is haemoptysis
  • treat any bleeding wounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you treat a palliative patient with major bleeding?

Why might a major bleed occur?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly