Palliative Care

Question 1

When is a patient deemed to be approaching the end of life

Answer 1

likely to die within the next 12 months

Those facing imminent death or those with:

• advanced, progressive, incurable conditions
• general frailty
• at risk of dying from sudden crisis of condition
• life threatening conditions caused by sudden catastrophic events

Question 2

Principles of delivering good end of life care

Answer 2

 Open lines of communication
 Anticipating care needs and encouraging discussion
 Effective multidisciplinary team input
 Symptom control – physical and psycho-spiritual
 Preparing for death - patient & family
 Providing support for relatives both before and after death

Question 3

what are some physical causes of pain

Answer 3

– Cancer related (85%)
– Treatment related
– Associated factors-cancer and debility
– Unrelated to cancer

Question 4

bone pain

Answer 4

– Worse on pressure or stressing bone / weight

bearing

Question 5

nerve pain

Answer 5

– Burning/shooting/tingling/jagging/altered sensation

Question 6

liver pain

Answer 6

– Hepatomegaly/right upper quadrant

tenderness

Question 7

 Raised Intracranial Pressure

Answer 7

– Headache (and/or nausea) worse with lying down, often present in the morning

Question 8

colic pain

Answer 8

– Intermittent cramping pain

Question 9

what are the three steps on the WHO palliative care pain ladder

Answer 9

step 1:
- non-opioid

step 2:

• weak opioid
• non opioid

step 3:

• strong opioid
• non opioid

Question 10

give me examples of step 2 opioids

Answer 10

dihydrocodeine

tramadol

Question 11

give me examples of step 3 opioids

Answer 11

diamorphine
fentanyl
oxycodone

Question 12

administration of opioids

Answer 12

• enterally - oral/rectal
• parenterally - im/sc injections
• delivery via synringe driver over 24 hours

Question 13

when would you switch an opioid

Answer 13

if the pain is opioid sensitive but has intolerable side-effects

Question 14

Side effects of opioids:

Answer 14

• nausea and vomiting
• constipation
• dry mouth
• biliary spasm
  watch for signs of opioid toxicity

Question 15

Opioid Toxicity

Answer 15

– Shadows edge of visual field – Increasing drowsiness
– Vivid dreams / hallucinations 
– Muscle twitching / myoclonus 
– Confusion
– Pin point pupils
– Rarely, respiratory depression

Question 16

Psycho-spiritual distress

Answer 16

the impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, nature, or a power greater than oneself.

Question 17

Psycho-spiritual distress: Management

Answer 17

• Encouraging hope, purpose and meaning
• Respecting religious/cultural needs,
• Affirming the patient’s humanity,
• Protecting the patient’s dignity, self worth and identity, • Encouraging relationships,
• Encouraging forgiveness/reconciliation,
• Refer to colleagues in wider MDT / specialist services

Question 18

Bereavement & Grief

Answer 18

• Anticipatory Grief
• Non-complex (normal) Grief (90-94%)
• Complex / Unresolved Grief (6-10%)
Grief is not a measure of the relationship between the bereaved and the deceased.