Palliative Care Flashcards
What is palliative care?
A care approach which focuses on quality of life management and family involvement in conditions that are a life threatening illness
What is the brief overall goal of palliative. Care?
Providing symptomatic relief and mental support to a patient with a lifer threatening condition
What are some conditions that a patient might have which would qualify them for palliative care?
Cancer
CCF
COPD
ESRF
Parkinson’s
Alzheimer’s
End stage liver disease
What is considered palliative care?
Patients receiving care when they are believed to be in the last 12months of life
What are the questions you should be asking yourself if you are deciding whether palliative care should be initiated on a patient?
Is their rapid decline in organ function and/or organ failure
Would you be surprised if the patient died in the next few months, weeks or days?
Are there general indicators of decline or patient not wanting treatment?
Are their specific clinical indications related to decline with a certain condition
What should you always assume before speaking to a patient about palliation and end of life plans?
Assume they have capacity until proven otherwise
What if a patient lacks capacity when coming to palliative care plans?
Check if they have an Advanced Directive and assess if it’s legally binding for the current situation.
What is the next step if a patient lacks capacity to make decisions regarding palliation and they do not have an advanced directive?
See if patient has a HEALTH Lasting Power of Attorney (they will make decisions on the patients behalf)
What should you do if a patient lacks capacity and doesn’t have an advanced directive or Health lasting power of attorney?
See if theres any family members or close friends that you can receive any potential input from, but essentially you still have to make the decision
What should you do if a patient lacks capacity, doesn’t have an advanced directive, Health lasting power of attorney or any close proxy’s?
Get in contact with an IMCA (Independant Mental Capacity Advocate)
A person non related to the patient who gives advice on the patients behalf, you can choose to act on their advice or not
What are some general symptoms that might need to be managed in palliative care/end of life care?
Pain
Agitation
Nausea+Vomiting
Anxiety
Constipation
Breathlessness
Insomnia
What medications can you give for pain in palliation?
Morphine via syringe driver
Oxycodone
When cant you give morphine so you have to give. Oxycodone?
When renal function is less than eGFR 30ml
What medication is given to reduce lung secretions in palliation?
Glycopyrronium (anticholinergic)
What medications
What medication can you give to manage agitation in palliation?
Midazolam
Haloperidol
What medication can you give to manage constipation in palliation?
Senna (stimulative)
LACTULOSE (osmotic)
Macrogol (osmotic)
Glycerin (rectal suppository)
How is breathlessness managed in palliation?
Management depends on the cause of the breathlessness
What are the main causes of breathlessness in palliation?
Fluid in lungs
Bronchoconstriction (COPD)
Anxiety
How is breathlessness managed in palliation if it’s caused by fluid in the lungs?
Diuretics
How is breathlessness managed in palliation if it’s caused by bronchoconstriction (COPD)?
Bronchodilators like salbbutamol or ipratropium bromide
How is breathlessness managed in palliation if it’s caused by anxiety?
Anxiolytics like midazolam
What are some medications that can be used to treat insomnia in palliation?
Atopic lone (benzo)
Antihistamine
Melatonin
What are the 4 most commonly prescribed anticipatory medications for palliative care?
Morphine (syringe driven)
Glycopyrronium (secretions)
Midazolam (agitation)
Haloperidol (anti-emetic)
What is a pro kinetic drug that can be given to. Constipated patients that is contraindicated in Parkinson’s disease?
Domperidone
What are some conditions that are considered palliative emergencies?
Spinal cord compression
SVC obstruction
Hypercalcaemia
Seizures
Hypercalcaemia
Neutropenic sepsis
Severe haemorrhage
How does an SVC obstruction present?
Breathlessness
Facial flushing
Increased JVP
How is Hypercalcaemia managed?
Fluids + bisphosphonates
What commonly causes Hypercalcaemia in palliation?
Ectopic production of PTH (SCC of lung)
Bony metastes
What is important to discuss with a patient going into palliative care?
Explore patients thoughts
Prognostics of illness
DNACPR
Any wishes
Family or friends?
Funeral planning
Specific spiritual or religious needs
Future care of children or dependants
What is important you do when putting a patient into palliative care?
Ensure patient comfort and needs
Symptom management
Discontinue unnecessary medications
