Palliative ** Flashcards
Palliative performance scale
5 objective measurements
LOC
Oral intake
Activity level
Disease evidence
Self care
LOADS
Domains of issues to discuss w/ pt
Physical (dyspnea, pain, constipation, nausea)
Emotional issues
Social issues (guardianship, wills, finances)
Spiritual issues
End of life wishes
How to manage Bleeding
Anticipatory care plan w/ dark sheets, warm blankets
TXA 1000mg TID
Sedate w/ versed, midaz or lorazepam
Cover with dark blankets/towels
How to manage Anxiety
Midazolam
Lorazepam
How to manage Bowel obstruction (partial vs complete)
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
How to manage Constipation
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
How to manage Delirium
Treat reversible causes
Haloperidol 0.5-1mg SC BID-QID PRN
How to manage Dyspnea
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
How to manage Fatigue
Dexamethasone 2-4mg PO/SC/IV once daily
How to manage Hypercalcemia
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
How to manage Hiccups
Baclofen 5-20mg Q6-12H
Gabapentin 100mg Q6-8H
How to manage Mouth care (thrush, ulcerations, debris)
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
How to manage Myoclonus
Clonazepam 0.5-2md PO QHS
Midazolam 0.5-1mg SC Q4H PRN or continuous SC
N/V Chemical cause - causes + rx
(opioid, steroid, chemo, metabolic)
Haldol 0.5-1.5mg PO/IV/SC/ BID-TID
Ondansetron 4-8mg PO/SC/IV
N/V cortical cause - causes + rx
(anxiety, pain, emotional fear)
Lorazepam 0.5-1mg SL QID PRN
Nozinan 3.125-6.25mg PO/SC Q8H