Palliative Care Flashcards
Discuss the definition and features of ‘approaching the end of life’
An individual who is likely to die within the next 12 months.
It can be due to:
Advanced, progressive incurable conditions
General frailty
At risk of dying from sudden crisis of condition
Life-threatening conditions caused by sudden catastrophic events
List the principles of delivering good end of life care
Open lines of communication
Anticipating care needs and encouraging discussion
Effective multidisciplinary team input
Symptom control (physical and psycho-spiritual)
Preparing for death (patient and family)
Providing support for relatives before and after death
What are some types and causes of pain in the palliative care setting?
Types of pain:
Background pain – there all the time
Breakthrough pain – controlled by analgesics but have bursts when it is not controlled
Incident pain – when someone is undertaking a specific action
Causes (can be multifactorial):
Physical causes (cancer related, treatment related, related to debility/immobility, unrelated to cancer)
Overlap of physical and psychospiritual causes (signs of this include: pain not being improved despite increasing analgesia or patient not being able to locate pain or describe it as ‘all over’)
Describe the different types of pain syndromes
Bone pain: worse on pressure/stressing bone or weight-bearing
Nerve pain: burning, shooting, tingling, jagging, altered sensation
Liver pain: hepatomegaly, right upper quadrant tenderness
Raised ICP: headache and/or nausea, worse when lying down, often present in the morning
Colic: intermittent cramping pain
Name the commonly used opioid medications used in palliative care (WHO step ladder)
Step 2 (weak): dihydrocodeine, tramadol
Step 3 (strong opioid): morphine (first-line), diamorphine, fentanyl, oxycodone
What is the role and benefits of syringe drivers in administering medication in end-of-life care?
Good to be used in patients who struggle/cannot swallow medication
avoids the need for repeat injections (improved comfort)
delivered steadily over 24hrs so it is good for providing a steady background analgesia
Rapid symptoms control
Multiple medications can be added
What are some signs of opioid toxicity?
Shadows at the edge of the visual field
Increasing drowsiness
Vivid dreams/hallucinations
Muscle twitching/myoclonus
Confusion
Pinpoint pupils
Respiratory depression (rare)
Describe the adjunct medication that can be prescribed alongside analgesia in palliative care
Liver pain/raised ICP: steroids eg. Dexamethasone, and might need gastroprotection too so prescribe PPI alongside it
Neuropathic pain: eg. Amitriptyline, gabapentin, carbamezepine
Bowel/bladder spasm: Buscopan (hyoscine butylbromide)
Bony pain/soft-tissue infiltration; NSAIDs/radiotherapy for metastases
Describe the factors that make up total pain
Physical factors: primary disease, treatment, co-morbidities, side effects etc.
Social factors: worries of family, financial concerns, loss of status/role, dependency etc.
Spiritual factors: loss of faith, angry at faith, fear of death/unknown, existential questions etc.
Psychological: feat of pain, experiences of past illnesses, anxiety, depression etc.
Describe ways to manage psycho-spiritual distress
Encouraging hope, purpose and meaning
Respect religious and cultural needs
Affirm patients’ humanity
Protect patient’s dignity, self-worth and identity
Encouraging relationships, forgiveness and reconciliation
