Palliative care

Question 1

aim of palliative care

Answer 1

care for incurable diseases to improve quality of life - prolong, symptoms management - offered at any point after diagnosis

Question 2

mimics of death

Answer 2

opioid and drug toxicity
sepsis or infection
hypercalcaemia
AKI
hypoglycaemia

Question 3

changes as approach death

Answer 3

weakness
fatigue
lost interest in food and fluids
breathing changes
dry mouth
anxiety
pain

Question 4

anticipatory medications which can be given

Answer 4

pain/SOB -> morphine
distress -> midazolam
nausea -> levomepromazine
secretions -> buscopan
dont give IV fluids as risk of fluid overload

Question 5

general mx of end of life

Answer 5

only continue essential medications and switch to non-oral route as will loose swallow (syringe driver)
anticipatory medications ready
look out for urinary retention
stop routine obs and monitoring and remove unused equipment
appropriate environment
hollistic support for pt and fam

Question 6

pain ladder

Answer 6

step 1 -> non-opioid (aspirin, paracetamol, NSAID) +/- adjuvant
step 2 -> weak opioid (codeine) +/- non-opioid +/- adjuvant
step 3 -> strong opioid (morphine) +/- non-opioid +/- adjuvant

Question 7

what targeting when giving pain relief

Answer 7

baseline constant pain -> slow release morphine (MST or Zomorph)
breakthrough pain -> immediate release morphine PRN - oramorph or sevredol

Question 8

how to calculate breakthrough pain dose of morphine

Answer 8

1/6 of total background dose

Question 9

what opioid to give if severe renal impairment and why

Answer 9

fentanyl or alfentanil as morphine is renally secreted so would build up and cause toxicity

Question 10

symptoms of morphine toxicity

Answer 10

hallucinations, myoclonus, drowsiness, respiratory depression

Question 11

what to do if respiratory depression due to morphine toxicity

Answer 11

measure RR throughout
reduce dose or switch to another opioid
give naloxone in small dosese every 2mins - careful as don’t want to reverse completely as will then be in severe pain

Question 12

electronic advance care plans outline what

Answer 12

CPR decisions
preferred place of care and death
anticipatory medications

Question 13

how to confirms death

Answer 13

[5 mins to assess minimum]
absense of pulse (>1min same for following)
absense of heart sounds
absense of respiratory sounds
no response to pain
fixed and dilated pupils

Question 14

must register death in what time frame

Answer 14

in 8 days