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Y4 Cancer care > Palliative care > Flashcards

Palliative care Flashcards

1
Q

What are features that tell you someone is in the last week of their life?

A
  • Progressive daily global deterioration
  • Nursed in bed and dependent for all care
  • Reduced oral intake
  • Difficulty swallowing tablets
  • Drowsiness and/or delirium
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2
Q

If the following are present, the prognosis is likely to be less than 48 hours:

A
  • Cheyne-Stokes breathing
  • Respiratory tract secretions
  • Peripheral cyanosis
  • Oliguria
  • Absent radial pulse
  • Loss of corneal reflex
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3
Q

What is the difference between psychologists and counselling?

A

Psychologists work with you before treatment- work to frame your attitude and help you to set goals

Counselling- talking therapy and clinics with therapists

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4
Q

What is the gold standards framework?

A

The Gold Standards Framework is a systematic approach to improving the quality and coordination of palliative care for patients nearing the end of life, focusing on early identification, symptom management, and advance care planning.

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5
Q

What does end of life mean?

A

Expected to die within the next 12 months

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6
Q

When does palliative care occur?

A

Happens alongside current treatment

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7
Q

Examples of how an occupational therapist could help in a palliative team

A
  • Hand rails down the stairs
  • Ramp installations
  • Voice activated devices
  • Electric can openers
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8
Q

Who are the allied healthcare professionals in palliative care?

A

Counsellors.
Dietitians.
Music therapists.
Occupational therapists.
Orthotists and prosthetists.
Pastoral care workers.
Pharmacists.
Physiotherapists.
Podiatrists.
Psychologists
Social workers.

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9
Q

What would happen if you knowingly ignored an advanced decision for a patient?

A

You could end up in jail charged with assult

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10
Q

What are the two types of Lasting Power of Attorney (LPA) and their respective functions?

A

Property and Financial Affairs LPA: Authorises an attorney to manage financial and property matters, such as paying bills and managing investments.

Health and Welfare LPA: Authorises an attorney to make decisions about personal welfare, including medical treatment and care, if the individual lacks capacity.

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11
Q

What is an Advance Decision to Refuse Treatment (ADRT) and its key requirements?

A

Definition: A legal document allowing individuals to refuse specific medical treatments in advance, should they lose capacity in the future.
Key Requirements: Must be made voluntarily, be informed, specific to the treatment being refused, and comply with legal formalities (written, signed, and witnessed).

Artificial nutrition, antibiotics, CPR, mechanical ventilation

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12
Q

What can you not refuse even if you have an advanced decision and lose capacity?

A
  • To refuse to be taken to hospital
  • It is not a medical decision
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13
Q

What is the difference between a lasting power of attorney and an advanced decision?

A

In summary, ADRTs are specific directives for refusing certain treatments, while LPAs involve appointing individuals to make a broader range of decisions on one’s behalf when they are unable to do so.

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14
Q

How can a clinician ensure that a patient’s advance decision to refuse treatment is valid?

A

Check Validity Criteria: Verify that the advance decision is written, signed, and witnessed, and that it clearly specifies the treatments to be refused.

Confirm Applicability: Ensure the decision is relevant to the patient’s current clinical situation and that the patient had capacity when making the decision.

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15
Q

How should clinicians approach decision-making for a patient with fluctuating capacity at the end of life?

A

Best Interests Approach: Base decisions on the patient’s best interests, considering their expressed wishes when they had capacity.
Reassess Capacity: Continuously assess the patient’s capacity to make decisions and adjust the care plan accordingly.

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16
Q

What is prescribed for a dry cough?

A

Codeine linctus

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17
Q

What is the difference between best supportive care and palliative care?

A

With BSC
- Not for any active chemo/radio/surgery

But you would still treat an infection, do blood transfusion. Not actually treating the cancer.

With palliative you may not prescribe antibiotics- would do nothing if the cancer is that advanced

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18
Q

List 4 techniques to help with breathlessness

A
  • Breathing exercises
  • Square breathing
  • Diazepam
  • Breath stacking
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19
Q

How do breathing exercises physiologically improve breathlessness in palliative care patients?

A

Breathing exercises reduce dyspnoea by
- Promoting diaphragmatic breathing,
- Reducing accessory muscle use
- Improving ventilation efficiency, thereby decreasing the sensation of breathlessness.

20
Q

Describe the mechanism behind square breathing in managing breathlessness and its role in anxiety reduction.

A

Square breathing (inhaling, holding, exhaling, and pausing for equal counts) engages parasympathetic pathways, promoting relaxation, reducing anxiety-induced hyperventilation, and stabilising breathing patterns.

21
Q

How does breath stacking work in managing breathlessness, and in what clinical situations is it particularly useful?

A

Breath stacking involves taking successive small breaths without exhaling fully, increasing lung volume and preventing atelectasis, particularly useful in patients with neuromuscular weakness or hypoventilation.

22
Q

What is the Gold Standards Framework (GSF) in palliative care, and how does it improve outcomes for patients nearing end-of-life?

A

GSF is a systematic approach to improve care for patients nearing end-of-life by identifying those in their last year of life, enabling earlier planning, symptom management, and ensuring dignity at the end stages.

Traffic light system

23
Q

Explain the traffic light system in the Gold Standards Framework and how it assists in palliative care prioritisation.

A

The traffic light system categorises patients based on prognosis: green (stable), amber (deteriorating), and red (actively dying). This system aids in resource allocation and triaging the urgency of care.

24
Q

What is asteroid hyalosis, and how does it present in patients?

A

Asteroid hyalosis is a benign condition where calcium-lipid deposits accumulate in the vitreous humour, causing visual disturbances like floaters, though it typically does not impair vision.

25
Q

What is the role of pre-emptive steroid use in palliative care, and in what situations might it be particularly beneficial?

A

Pre-emptive steroids are given before the onset of symptoms (e.g., in cases of potential cerebral oedema from brain metastases) to prevent acute complications, ensuring symptom control before crises occur.

26
Q

How do anticipatory steroids differ from pre-emptive steroids, and what are their uses in palliative care?

A

Anticipatory steroids are prescribed in advance but administered at the onset of specific symptoms (e.g., dyspnoea, nausea from intracranial pressure), allowing rapid response once symptoms manifest.

27
Q

Why are anticipated emergencies on the RESPECT form often ineffective, and what improvements could be made to enhance their utility?

A

Anticipated emergencies are often generic and not tailored to the individual’s disease trajectory, leading to suboptimal emergency responses. Personalising these sections with specific clinical details could improve decision-making during acute events.

28
Q

Methods to help hicccups

A

Breath holding and sipping cold water

haloperidol, gabapentin are also used
dexamethasone is also used, particularly if there are hepatic lesions

29
Q

What are the principles of palliative care?

A
  • Provides relief from pain and other distressing symptoms
  • Affirms life and regards dying as a normal process
  • Integrates psychological and spiritual aspects of care
  • Will enhance the quality of life
  • Uses a team approach to address the needs of patients and their families.
30
Q

What types of pain will opioids do well with?

A
  • Soft tissue pain
  • Visceral pain
31
Q

What is preferrable in end of life care for seizures?

A

Midazolam

32
Q

How does Hyoscine Butylbromide/Glycopyrroniium work?

A

Anti-muscarinic receptor drug
Hyoscine Butylbromide is an anticholinergic drug which acts on the muscarinic receptors in the gastrointestinal tract, producing relaxation of the smooth muscle cells and reduces production of secretions.

33
Q

Which tests are used to screen for hepatocellular carcinoma every 6 months in high-risk patients?

A

AFP and ultrasound of the liver

Patients at high risk of hepatocellular carcinoma (including those with alcoholic liver disease, hepatitis B, hepatitis C, haemochromatosis and alpha-1 antitrypsin deficiency) are offered 6–12 monthly screening with AFP (a tumour marker) and an abdominal ultrasound.

34
Q

Discuss the criteria for prescribing midazolam in the context of managing severe dyspnoea in terminal patients.

A

Significant anxiety or agitation.

Typical dosage: 2.5-5 mg subcutaneously or intravenously

Monitor for respiratory depression and sedation; reassess frequently to adjust dosage and ensure optimal symptom management.

35
Q

Assess the role of dexamethasone in the management of dyspnoea due to malignancy-related airway obstruction.

A

Indicated for inflammatory airway obstruction or tumour-related dyspnoea.
Typical dosage: 8-16 mg orally or intravenously, depending on severity and clinical judgement.
Monitor for side effects, including hyperglycaemia and potential impact on mood, and reassess the need for ongoing treatment.

36
Q

Outline the criteria for initiating oxygen therapy in palliative care patients with dyspnoea.

A

Indicated for patients with SpO₂ ≤ 92% (symptomatic hypoxaemia).
Avoid routine use for non-hypoxaemic breathlessness.
Consider trial of short-burst oxygen for planned activities.

37
Q

What is the strength difference between oral oxycodone and oral morphine?

A

Oral oxycodone is twice as potent as oral morphine so half the dose should be prescribed. Oxycodone is less likely to accumulate in moderate renal impairment, but expert advice might be required in more severe renal failure.

38
Q

What is the first line and second line management for hiccups?

A

1st- Chlorpromazine or Haloperidol

2nd- Baclofen is a muscle relaxant used for persistent hiccups, particularly those related to neurological causes, but it is considered when first-line pharmacological treatments like chlorpromazine have failed.

39
Q

What is the difference between fentanyl and alfentanyl?

A

Alfentanyl is not as strong

40
Q

What are SWAN plans?

A

Signs
Words
Actions
Needs

Day by day plan- up to 8 days
Summary of commincation with family

Key Components of a SWAN Plan:
Patient-centred care that addresses physical, emotional, and spiritual needs.
Clear communication with family members, offering emotional support and regular updates.
Proactive symptom management through anticipatory medications.
Consideration of nutrition and hydration, focusing on comfort rather than artificial prolongation of life.
Holistic care that involves chaplaincy or spiritual teams as part of the end-of-life process.

41
Q

Structure of cancer services

A
  • NHS framework
  • Cancer alliances- regional partnerships
  • MDTs
  • Cancer treatment centres- specialised facilities that can provide advanced cancer treatments.
42
Q

Structure of palliative care services

A
  • Holistic palliative care model
  • Specialised palliative care teams
  • Care settings- hospice, hospital palliative care units
  • Community based services
  • NHS and local health partnerships
43
Q

Regarding care of the dying patient: * Describe an ethical framework to solve ethical dilemmas commonly encountered in patients with advanced cancer

A

Autonomy- open discussions, patients are fully informed

Beneficence- potential benefits of treatments

Non-maleficence- risks and burdens of proposed treatments

Justice- all patients receive appropriate care

44
Q

Pre-emptive medications for palliative care

A

Pain- morphine sulphate
N&V- Haloperidol
Agitation- Midazolam
Secretions- Hyoscine butylbromide

45
Q

Demonstrate an understanding that a patient is dying

A

Cheyne-stokes breathing
Coma
Lethargy
Mottling and cold extremities
Anorexia/dysphagia
Confusion and delirium
Nausea and vomiting, changes in bowel habits
Death rattle- last hours

Y4 Cancer care (15 decks)

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