Palliative And End Of Life Care Flashcards
What is palliative care ?
The active total care of the patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms and of social,psychological and spiritual is paramount
What is meant by end of life care ?
Patients are approaching the end of life when they are likely to die within the next 12 months
What are the 3 most common causes of death in the UK ?
CVD
Cancer
Respiratory disease
What are some barriers to recognising deterioration ?
Unclear diagnosis or prognosis
Complex / difficult
Lack of knowledge
Disease focused rather than patient focused
Fear
Don’t want to destroy hope
What are general indicators of decline ?
Unplanned hospital admissions
Performance status is poor or deteriorating
Dependent on others
Significant weight loss
Persistent symptoms despite optimal treatment
What are some features of the dying phase ?
Cheyne-stokes respiratory pattern
Shallow breathing
Use of accessory muscle for breathing
Respiratory secretions
Skin colour changes
Decreasing levels of consciousness
Urinary problems
Difficulty swallowing
What are some common symptoms of dying and how are they managed ?
Pain - morphine 2.5-5mg SC
N + V - levomepromazine 2.5-5mg SC
Breathlessness - morphine 2.5-5mg
Restlessness or agitation - midazolam 2.5-5mg SC
Resp secretions - glycopyronium 200-400mcg SC
What are some common causes of N+V ?
Infection
Renal and hepatic impairment
Drug related - opioids, chemo
Gastric stasis
GI disturbance - constipation
Raised ICP
Anxiety / fear
What are some causes of breathlessness to consider ?
Anaemia
PE
Cardiac failure
Resp infections
Pleural effusion
Pericardial effusion
SVCO
Anxiety
Which anti-emetic should be used for chemical causes of N +V ?
Haloperidol
Which anti-emetic should be used for gastric stasis causing N + V ?
Metoclopramide
Domperidone
Which anti-emetic should be used for obstructive causes of N +V ?
Cyclizine
Dexamethasone
Which anti-emetic should be used for raised ICP causing N +V ?
Cyclizine
Dexamethasone
Which anti-emetic should be used for psychological causes of N +V ?
Non drug
Benzo
Which anti-emetic should be used for post-op causes of N +V ?
Ondansetron
