Palliative care Flashcards
what is palliative care
how is it done
approach that improves the QofL of paitnets and their families facing problems associated with life-threating illness
through prevention and relief of suffering
by early identification and assessment, treatment of pain (physical, psychosocial and spiritual)
what is approaching end of life
likely to die within 12 months
who else get end of life care
facing imminent death
advanced incurable conditions
general fraility
at risk of dying from sudden crisis of condition
life threatening by sudden catastrophic events
what are principles of delivering good end of life care
ADVANCED and ANTICIPATORY care
preparing family and patient for death
what are typical pain patterns for end of life patients
and pain syndromes
BACKGROUND
BREAKTHROUGH
INCIDENT
bone
nerve
liver
raised intracranial pressure
colic
what pain tool do you use instead of SOCRATES
brief pain inventory
done for pain in last 24 hours
-acute
what is the WHO alagesic ladder for cancer pain
step1
non-opioid
-paracetamol, aspirin, NSAID
with/without adjuvent
step2
weak opioid
-codeine
with/without non-opioid and adjuvent
step 3
strong opioid
-morphine
with/without non-opioid and adjuvant
what are some step 2 drugs
codeine
dihydrocodeine
tramadol
what are some drugs for step 3
morphine
diamorphone
fentanyl
oxycodone
what are the two indications for morphine
moderate/severe pain
dyspnoea
how does morphine act
act on opioid receptor agonist
centrally acting
what are some morphine cautions
renal impairment
elderly
how do you administer morphine
oral/rectal
IM/SC injections
syringe driver over 24 hours
when do you use modified release morphine
for BACKGROUND PAIN
twice daily at 12 hour intervals
once daily at 24 hour intervals
when do you use immediate release morphine
for BREAKTHROUGH PAIN
as required
-oramorph liquid
sevredol tabs
what is diamorphine used for and why
semi-synthetic morphine
more soluble therefore smaller volumes needed
parenteral administation
what are second line opioids
if cant tolerate morphine
oxycodone
-less hallucinatoins, itch, drowsiness, confusion
fentanyl patch
-lasts 72 hours
what are opioid side effects
N and V
Constipation
dry mouth
biliary spasm
monitor for opioid toxicity
manage opioid side effects
constipation
-laxative
-senna/bisacodyl and docusate
-magrogol
-co-danthramer alone
nausea
-antiemetic
-metoclopramide
-haloperidol- QT interval awareness!!!!
what is opioid toxicity
shadows edge of visual field
increasing drowsiness
vivid dreams/hallucinations
muscle twitching/myoclonus
confusion
pin point pupils
rarely/ respiratory depression
what adjuvants can you use
Liver capsule pain/raised intracranial pressure – Steroids (e.g. Dexamethasone) – Remember to consider gastroprotection
Neuropathic pain – Amitriptyline/ Gabapentin/ Carbamazepine
Bowel/ bladder spasm
– Buscopan (Hyoscine Butylbromide)
Bony pain/ soft-tissue infiltration – NSAIDs/ Radiotherapy for bony metastas
what is a syringe driver used for
delivery over 24 hours (SC)
GOOD WHEN CANT USE ORAL
GOOD FOR RAPID control
-stigma
what are the 4 aspects to consider with end of life care/ TOTAL PAIN care
PHYSICAL
SOCIAL
SPIRITUAL
PSYCHOLOGICAL
what is psycho-social distress
impaired ability to experience and integrate meaning and purpose in life
through connected with seld/others/nature. power
-if individual beliefs challenged
how did covid 19 affect grief
decreased professional support
strains on informal care netowrks
reduced quality of life
increased loss, grief and bereavement
discuss the percetanges of grief from bereavement
90-94% grief is NON-COMPLEX
6-10% COMPLEX/ unresolved- eg. become unwell
therefore most only require support and space rather than medication
what is most important essence of palliative and bereavement care
LISTENING
