palliative care Flashcards
what is palliative care?
“……..an approach to care that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual”
what are the principles of palliative care?
Focus on quality rather than quantity of life
Effective symptom management
Life affirming but death accepting
Effective communication at all levels
Respect for autonomy and choice
Holistic, multi-professional approach
Caring about the person and those that person cares about
what does patients want?
To receive the best treatments
To be treated with dignity and respect
To be involved in decisions about treatment and care.
Information about their condition, possible treatments and services.
To be offered optimal symptom control and psychological, social and spiritual support.
To be able to die in the place of their choice, often at home.
Their families and carers to get support during their illness and if they die.
-symptoms control
what are attributes for a good death in patients?
being able to be in mentally alert and in control until death - involved decisions
being comfortable - pain and symptoms controlled
recognition of impending death and a sense of closure
beliefs and values honoured
trust in care providers
relationship optimised with family and friends - burden minimised from family
family cared for
death preferred in place of care
religious prayers or meditation
personal affairs in order
leaving a legacy
Approaching palliative care
Palliative care should be delivered by any HCPs in the care setting of patient’s choosing
Palliative care should begin at diagnosis of life-threatening condition, continuing through to death/ bereavement
Services should be available on a 24/7, to prevent unnecessary suffering
Specialist Palliative Care is delivered using multi-professional team
Specialist Palliative Care is needed by only a minority of people with complex problems
what are Specialist palliative care services and what are their role
Many patients with advanced cancer have complex symptoms that cannot be managed by generalist services
Specialist services include hospices and specialist palliative care services (primary and secondary care services)
Specialist palliative teams:
Advise on management of symptoms
Provide information on diagnosis, investigations and treatments
Offer emotional, spiritual and social support
Liaise closely to improving the patient’s quality of life
Offers support via education to healthcare staff
what are the common side effects of palliative care?
Pain
Sedation
Dyspnea
Delirium
Anorexia
Respiratory congestion
Nausea & Vomiting - chemotherapy
Anxiety - diagnosis, family
Bowel obstruction
Constipation - recieving opoids
insomnia
Diarrhea
what is the symptom control of pain?
step 1: non-opiod (paracetamol, NSAIDs, aspirin)
step 2 - weak opiod for mild-moderate pain (codeine)
step 3 - strong opiod for moderate to severe pain (morphine)
Neuropathic Pain: gabapentin and pregabalin
ketamine
dexamethasone (pain due to nerve compression
commonly which opiods are used in palliative care
moderate to severe
Opioids commonly used in palliative care are buprenorphine, diamorphine, fentanyl, morphine and oxycodone
when You inject morphine, or take it orally and it binds the same opioid receptors that are bound by endogenous pain killers, endorphins. Activation of these receptor switch off the pain response. Opioids are agonist of the opioid receptors and what they do the inhibit presynaptic receptor and therefore block pain signals. This is not just for morphine, but also codeine,oxicotin.. They are drugs of choice for severe pain, and the problem is not that they are bad drugs, they are great drugs, but they have a lot of side effects. And this is because the opiate receptor is not just in the nociceptive pathway, these receptors are all over the place in the nervous system.
what are the supra-spinal action and spinal action?
what symptoms needs to be controlled?
Pain
Breathlessness
Gastro-intestinal symptoms
Mental health/psychological support
what are the side effects of opioids and how can you control this?
Convulsions: consider prophylactic treatment with carbamazepine or phenytoin
diazepam or phenobarbital when oral medication is not possible
Nausea and vomiting: metoclopramide hydrochloride or haloperidol; cyclizine
Antiemetic therapy should be reviewed every 24 hours
Dry mouth: chewing sugar-free gum if associated with candidiasis, oral preparation of nystatin or miconazole
Constipation: Regular administration of laxatives
Methylnaltrexone bromideis licensed for the treatment of opioid-induced constipation.
summary:
Families and carers should also be considered
Effective palliative care requires an effective multi-disciplinary team
Pharmacists have a key role to play in symptom control and provision of information
