Palliative Care

Question 1

List individuals who should get palliative care.

Answer 1

1. Client is in bed or chair 50% or more of the day
2. Client is dependent on others for most care
3. Client has 2 or more unplanned visits to the hospital in the past 3 months
4. Client has an advanced disease and wants palliative care only but not curative treatment
5. The client has an advanced disease that is resistant to therapy

Question 2

List 8 conditions that need palliative care if not responding to treatment.

Answer 2

Lungs: COPD, TB
CVS: Heart failure and critical limb ischemia
Renal: Chronic kidney disease stage 4/5
Liver: Advanced liver cirrhosis with any of the following: hepatic encephalopathy, variceal bleeds, ascites resistant to diuretics, hepatorenal syndrome and bacterial peritonitis
Malignancy: Including hematological ones
Neuro: Stroke and dementia
Infection: HIV and TB

Question 3

Can you start palliative care while a patient is being given curative treatment?

Answer 3

Yes

Question 4

What are the clinical signs that a client with a self limiting condition is dying?(4)

Answer 4

Bedridden
Only able to sipmfluid
Unable to take tablets
Decreased level of consciousness

Question 6

Outline the pain ladder.

Answer 6

1. Paracetamol or Ibuprofen
2. Tramadol
3. Morphine sulphate or morphine chloride
   Add amitriptyline if there is nerve or central pain.

Question 7

Who should get morphine during palliative cancer?

Answer 7

Only cancer patients

Question 8

Outline common symptoms seen in palliative care and how each is relieved.(7)

Answer 8

Constipation: SENNOSIDS A and B or lactulose
Abdominal pain: Hyoscine butylbromide
Pain: following the ladder
Vomiting: Metoclopramide
Diarrhoea: Loperamide
Generalized itchiness: Chlorpheniramine
Acute anxiety: lorazepam

Question 9

What is breakthrough pain?

Answer 9

Pain that occurs before the second scheduled dose of morphine

Question 10

Adverse effect of amitriptyline

Answer 10

Sedation(drowsiness and dizziness)
Antidepressant

Question 11

What is the criteria to move up the pain management ladder?

Answer 11

Pain persist for >2 days or worsens after maximal dose

Question 12

List the criteria for the diagnosis of death.

Answer 12

No carotid pulse for 2 minutes and no heart sounds for 2 minutes and no breath sounds or chest movement for 2 minutes and pupils are fixed, dilated and do not respond to light.

Question 13

What is the predicted time of death in someone with a progressive organ failure?

Answer 13

2-5 years

Question 14

What is the predicted prognosis of cancer in palliative care?

Answer 14

Usually does within 2 months but some survive few years

Question 15

What is the predicted prognosis of dementia in palliative care?

Answer 15

Up to 5-8 years

Question 16

List top twelve symptoms in order.

Answer 16

Feeling drowsy
Pain
Lack of energy
Shortness of breath
Dry mouth
Worrying
Cough
Difficulty sleeping
Feeling nervous
Changes in skim
Feeling sad
Feeling irritable

Question 17

Define pre cachexia

Answer 17

Weight loss of 5% or less
Anorexia nervosa and metabolic changes

Question 18

Define cachexxia

Answer 18

Weight loss >5%
Or
BMI<20 and weight loss>2%
OR
Sarcopenia and weight loss>2%

Often reduced food intake/systemic inflammation

Question 19

Define refractory cachexia.

Answer 19

Occurs when cancer is both procatabolic and resistant to therapy and is characterized by a low performance and survival of <3 months

Question 20

List three pharmacological management of fatigue in palliative care

Answer 20

Corticosteroids mainly dexamethasone (effect last for 2-4 weeks9
Megestrol acetate
Psycho stimulants such as methylphenidate

Question 21

What are the non pharmacological treatments of fatigue in palliative care?(4)

Answer 21

Lifestyle modification: OT
Exercise: Physiotherapist
Counselling by dietician
Education about the reasons of fatigue and difference between irreversible and reversible fatigue and practical tips