Palliative ** Flashcards

1
Q

Palliative performance scale
5 objective measurements

A

LOC
Oral intake
Activity level
Disease evidence
Self care

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2
Q

Domains of issues to discuss w/ pt

A

Physical (dyspnea, pain, constipation, nausea)
Emotional issues
Social issues (guardianship, wills, finances)
Spiritual issues
End of life wishes

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3
Q

How to manage Bleeding

A

Anticipatory care plan w/ dark sheets, warm blankets
TXA 1000mg TID
Sedate w/ versed, midaz or lorazepam
Cover with dark blankets/towels

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4
Q

How to manage Anxiety

A

Midazolam
Lorazepam

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5
Q

How to manage Bowel obstruction (partial vs complete)

A

Partial:
Prokinetic: Metoclopramide
Anti-emetic: Haloperidol
Anti-spasmodic: Hyoscine butyl bromide Steroid: dexamethasone 2-4mg

Complete:
Avoid prokinetic
Continue anti-emetic, anti-spasmodic + steroid
Octreotide 100-300mcg SC BID

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6
Q

How to manage Constipation

A

Optimise diet, fibre, hydration + physical activity
PEG 3350 17g OD-BID
Lactulose 15-30ml PO OD-BID
Bisacodyl 5-10mg PO or PR
Glycerin suppository

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7
Q

How to manage Delirium

A

Treat reversible causes
Haloperidol 0.5-1mg SC BID-QID PRN

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8
Q

How to manage Dyspnea

A

Breathing method, position, fan, air flow
Morphine 2.5-5mg SC Q1H
HM 0.5-1mg SC Q1H
Bronchodilators
Lasix 40mg SC Q6H PRN
Dexamethasone 4-8mg PO/SC/IV Q12-24H

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9
Q

How to manage Fatigue

A

Dexamethasone 2-4mg PO/SC/IV once daily

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10
Q

How to manage Hypercalcemia

A

Corrected: calcium + (40 - albumin x 0.2)
Hydration with NS
Pamidronate 90mg IV in 500ml NS @ 125ml/hr Q4w PRN
Zoledronic acid 3-4mg IV over 15mins q3-4weeks

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11
Q

How to manage Hiccups

A

Baclofen 5-20mg Q6-12H
Gabapentin 100mg Q6-8H

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12
Q

How to manage Mouth care (thrush, ulcerations, debris)

A

Thrush: ketoconazole 200mg PO x5 days or nystatin 500,000 units (5ml) swish + swallow QID x 1 week
Ulcerations: lidocaine 2% viscous or 10% spray
Debris: 3% hydrogen peroxide

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13
Q

How to manage Myoclonus

A

Clonazepam 0.5-2md PO QHS
Midazolam 0.5-1mg SC Q4H PRN or continuous SC

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14
Q

N/V Chemical cause - causes + rx

A

(opioid, steroid, chemo, metabolic)
Haldol 0.5-1.5mg PO/IV/SC/ BID-TID
Ondansetron 4-8mg PO/SC/IV

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15
Q

N/V cortical cause - causes + rx

A

(anxiety, pain, emotional fear)
Lorazepam 0.5-1mg SL QID PRN
Nozinan 3.125-6.25mg PO/SC Q8H

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16
Q

N/V cranial cause - causes + rx

A

(increased ICP, meningeal infiltration, radiation)
Gravol 50mg PO/SC/PR Q4H
Dexamethasone 8mg

17
Q

N/V vestibular cause - causes + rx

A

(motion induced, drugs, cerebral tumor)
Gravol 25-50mg PO/IM/IV Q4H

18
Q

N/V visceral cause - causes + rx

A

(bowel obstruction, constipation, mesenteric)
Gravol 50mg PO/SC/PR Q4H

19
Q

N/V gastroparesis cause - causes + rx

A

(drugs, ascites, hepatomegaly)
Metoclopramide 10mg PO/ IV/ SC QID (w/ meals + QHS)
Domperidone 10-20mg PO QID (w/ meals + QHS)

20
Q

How to manage resp secretions

A

Hyoscine 0.4-0.6mg SC Q4H
Glycopyrrolate 0.2-0.4mg SC Q4H

21
Q

How to manage anorexia

A

RD
Nutritional support
Megestrol 160-800mg once daily
Dexamethasone 4-8mg PO QAM + PPI
Domperidone or metoclopramide 10mg PO TID

22
Q

How to pronounce death

A

Confirm and Document
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
Notify family if not present

23
Q

Hypercalcemia rx in palliative care

A

fluids, bisphosphonate, calcitonin/ steroids

24
Q

SVC obstruction sx

A

SOB, feeling of fullness in head, swelling of upper body/ face, hoarseness, CP at rest

25
Q

SVC obstruction rx

A

dexamethasone, opioids, benzos, stent/ chemo/ RT