Palliative care

Question 1

Define palliative care:

Answer 1

An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by treatment of pain and other physical, psychosocial and spiritual problems.

Question 2

Model of care for palliative patients:

Answer 2

1. Primary palliative care (primary care): provide learning and development opportunities for primary and secondary care providers
2. Consultation - liaison (intermediate care): provide consultation and advice to primary and secondary care providers
3. Shared care (intermediate care): with primary and secondary providers
4. Direct care (complex care): in the community and in designated beds

Question 3

Potential symptoms to deal with:

Answer 3

• Pain
• Xerostomia (dry mouth)
• Anorexia/cachexia
• Nausea/vomiting
• Dehydration
• restlessness
• confusion
• dyspnoea
• fatigue
• constipation
• diarrhoea
• pruritus

Question 4

Types of pain:

Answer 4

• Somatic
• Visceral pain
• Neuropathic

Question 5

Somatic pain

Answer 5

• Superficial: skin, mucous membranes
• hot, sharp, stinging, well localised
• eg. malignant ulcers, mucositis
• Deep: connective tissues, lymph nodes, organ capsules
• dull, ache, throbbing, well localised, incident & referred pain
• eg. bony metastases, liver capsule pain

Question 6

Visceral pain

Answer 6

• organs, deep tumours, deep lymph nodes
• dull, deep, cramping pain, poorly localised, referred pain
• eg. deep abdominal/mediastinal masses

Question 7

Neuropathic pain

Answer 7

• shooting, stabbing or burning
• caused by damage to or dysfunction of the nervous system
  eg. allodynia, hyperalgesia, hyperpathia

Question 8

Syringe drivers

Answer 8

• Constantly applies analgesia over 24hrs

Question 9

Causes of nausea & vomiting:

Answer 9

• The disease itself
• medication
• chemo/radiotherapy
• constipation
• chemical imbalance
• hormonal imbalance
• anxiety and fear
• mechanical obstruction
• *must be treated because it will affect appetite

Question 10

Fatigue: causes & management

Answer 10

• related to lack of sleep, low O2, poor diet, depression, chemo/radiotherapy, infection, disease
• management: energy conservation, management of sleep disturbance, treatment of underlying cause, rest periods

Question 11

Dyspnoea/breathlessness: causes & management

Answer 11

• causes: lung disease, asthma, emphysema, chest infection, pressure from other body organs, anaemia, anxiety
• management: comprehensive assessment, symptomatic relief, energy conservation, drugs, trials of oxygen

Question 12

Constipation:

Answer 12

• patient on opioids require aperients
• faecal impaction can be life-threatening
• can lead to nausea & vomiting, agitation

Question 13

Pruritus

Answer 13

• itching is a form of pain and needs to be treated with the same concern
• can be caused by severe liver or renal disease or failure
• goal of care: reduce symptoms, protect skin

Question 13

Pruritus

Answer 13

• itching is a form of pain and needs to be treated with the same concern
• can be caused by severe liver or renal disease or failure
• goal of care: reduce symptoms, protect skin

Question 14

Dehydration:

Answer 14

• Symptoms: headache, nausea, vomiting, cramps, dry mouth, cracking of oral mucosa and inflammation
• often iatrogenic (medically created) due to medications (eg. morphine, anti-depressants, anti-nausea
• Management:
• rehydration often causes more problems than it cures
• small, frequent sips to satisfy thirst
• icy-poles/ice chips
• keep mouth clean and moist

Question 15

Characteristics of a good assessment:

Answer 15

• acknowledges patient goals of care
• assess whole person and family unit
• standardised tools can support practice and provide information
• is proactive
• facilitates collaboration

Question 16

Goals of care:

Answer 16

• maintaining and improving function
• staying in control
• relief of suffering
• living well
• quality of life
• pain and symptom management
• relieving burden for family members
• strengthening relationships
• preferences for location of care/death
• life closure/dying well

Question 17

Assess needs for support/referral:

Answer 17

• 24/7 support
• home support, equipment or supplies
• psychosocial care for person/family
• spiritual care
• disease management
• preparing for dying
• bereavement process

Question 18

Characteristics of end-stage care:

Answer 18

• sleepiness and difficulty waking (semi-conscious)
• difficulty swallowing or not wanting to eat/drink
• incontinence
• restless movements
• changes in breathing - noisy
• temperature changes
• cold feet, hands, legs, arms
• confusion and disorientation
• complete loss of consciousness

Question 19

Markers of the dying phase:

Answer 19

• patient withdrawing
• refusing tablets, food, drink, basic care
• decreased oral intake
• decreased circulation, tachycardia, mottling
• changes in breathing patterns with respiratory congestion or apnoea
• changes in level of consciousness
• confusion, agitation, delirium
• changes in perception

Question 20

Define bereavement

Answer 20

the loss of a significant person and also the period of adjustment for the bereaved after the loss

Question 21

Define grief

Answer 21

The normal response to the loss of someone or something precious

Question 22

Define mourning

Answer 22

the social expression of grief after a death, associated with rituals and behaviours within the appropriate religious and cultural context

Question 23

Who can verify and certify death?

Answer 23

Medical practitioners, nurses, midwives and paramedics can verify death.
Only medical practitioners can certify death.