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Year 3 Human Disease > Palliative care > Flashcards

Palliative care Flashcards

1
Q

functions of palliative care 7

A
  • provide relief from pain and other distressing symptoms
  • affirms life and regards dying as natural process
  • integrates psychological and spiritual aspects of pt care
  • offers a support system to help patients live as actively as possible until death
  • offers a support system to help the family cope during the patients illness and in their own bereavement
  • enhances quality of life and may also positively influence the course of illness
  • come up with end of life strategy (advanced care planning)
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2
Q

does palliative care hasten or postpone death?

A

neither

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3
Q

when in the disease process is palliative care applicable

A

early in the course of illness in conjunction with other therapies that are intended to prolong life eg chemo/ radiotherapy, including investigations needed to better understand and manage distressing clinical complications
can also build relationship with pt and have advanced care planning

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4
Q

how many people die annually in the uk

A

50 000

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5
Q

% of where people die in the uk

A

58% hospital
18% at home
17% care home
4% hospices (due to low availability)

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6
Q

7 most common illnesses needing palliative care

A
  • cancer (75%)
  • chronic lung disease
  • chronic liver disease
  • end-stage kidney disease
  • advanced neurological disorder esp MN
  • dementia
  • fraility (old age)
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7
Q

define generalist palliative care

A
  • provided for those affected by life-limiting illness as part of standard clinical pratice by ANY HEALTHCARE PROFESSIONAL providing usual practice
  • provided in the community by general practice teams, allied health teams, district nurses, residential care staff, community support services, community paediatric teams
  • provided in hospital by general adult/ paediatric medical and surgical teams plus disease specific teams (oncology, respiratory etc)
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8
Q

define specialist palliative care

A
  • palliative care provided by those who have undergone SPECIFIC TRAINING OR ACCREDITATION in palliative care or medicine working in the context of a multidisciplinary team of palliative care health professionals
  • builds on general palliative care with higher level of expertise in complex symptom management, psychosocial, cultural and grief and loss support
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9
Q

2 ways palliative care division works

A
  • provides direct care to pts with life limiting illness

- advising other carers eg general palliative care as to when to refer

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10
Q

common symptoms of pts with incurable cancer

A
  • fatigue
  • pain
  • weakness
  • loss of appetite
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11
Q

explain oral changes in pts with incurable cancer 5

A
  • dry mouth
  • taste changes
  • sore mouth
  • dysphagia
  • hoarseness

these symptoms make pts not want to eat –> weight loss and giving up on life- food is one of the few sources of pleasure to a lot of people

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12
Q

orally related symptoms with incurable head and neck cancer 4

A
  • voice changes, eg due to tracheostomy
  • difficulty speaking
  • head and neck oedema
  • dysphagia
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13
Q

5 role of dentist in cancer pts

A
  • diagnosis of early suspicious lesions
  • prophylaxis (checks pre-radiotherapy, pre-chemotherapy, pre-bone marrow transplant to prevent infections with decreased immunity during tx)
  • advice re caries/ periodontal disease during tx (increased risk due to immunosuppressant)
  • diagnosis of complications of complications of tx
  • advice re oral care
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14
Q

3 causes of xerostomia in cancer pts

A
  • tumour (of salivary glands)
  • radiotherapy (less saliva, salive more viscous)
  • drugs 4 (opioids, anticholinergics, antipsychotics, anxiolytics)
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15
Q

6 problems of xerostomia

A
  • inc ris of caries
  • dry mouth is more acidic –> bacteria grow –> caries
  • dry, cracked lips
  • angular cheilitis (also due to anaemia)
  • problems wearing dentures
  • difficulty eating, swallowing, communication
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16
Q

treatment of xerostomia 8

A
  • treat underlying cause where poss (eg change meds)
  • good oral care
  • frequent sips of water (best)
  • ice chips
  • pineapple (sialogogue, inc saliva flow rate)
  • effervescent vitamin c
  • saliva substitutes
  • chewing gum (2nd best)
17
Q

2 factors inc oral thrush in cancer pts

A
  • dry mouth

- low immunity

18
Q

3 roles of dentist in oral thrush in cancer pts

A
  • diagnosis
  • advice on management, esp with azole resistance
  • advice on denture care (treat dentures too or they re-infect pt)
19
Q

4 ways to manage sore mouth

A
  • treat underlying cause if poss
  • good oral care
  • bland foods
  • local measures
20
Q

6 local measures used to treat sore mouth

A
  • gelclair (mechanical barrier)
  • difflam spray (LA. bad, causes stinging)
  • MuGard oral rinse (mucoadhesive, becomes barrier to mucosa)
  • bonjela
  • soluble aspirin (local antiinflammatory)
  • oramorph (topical analgesic)
21
Q

2 ways to treat oral pain

A
  • local measures as for sore mouth

- analgesics as per WHO pain/ analgesic ladder

22
Q

what is the WHO pain/analgesic ladder

A 
1= non-opioid + adjuvant: aspirin/ paracetamol/ NSAID
2= mild- moderate opioid (+non-opioid, adjuvant): codeine
3= strong opioid (+1 and 2): morphine, oxycodone, fentanyl
23
Q

with what illnesses is drooling common (6 examples)

A

neurological conditions:

  • MN
  • head and neck cancer
  • Parkinson’s
  • brain tumours
  • cerebral palsy
  • stroke
24
Q

2 causes of drooling

A
  • overproduction of saliva

- inability to swallow normal amounts of saliva

25
Q

5 ways to manage drooling

A
  • positioning (on side)
  • skin protection (vaseline, pad under face)
  • suction
  • drugs to dry secretions
  • radiotherapy to dry mouth (rare)
26
Q

2 drugs used to dry secretions and stop drooling

A
  • hyoscine butylbromide

- glycopyrronium

27
Q

what is ‘death rattle’

A

pts breathe through saliva pooled at back of throat (pts unaware but distressing for relatives)

28
Q

causes of osteonecrosis of the jaw 3

A

oversuppression of bone turnover:

  • bisphosphonates
  • multiple myeloma
  • bony metastatic disease
29
Q

5 symptoms of osteonecrosis of jaw

A

-pain
-swelling
-loosening of teeth
-exposed bone
-numbness or heaviness of jaw
(may be asymptomatic)

30
Q

2 methods to prevent osteonecrosis of the jaws

A
  • elimation of all sites of potential infection before tx

- avoidance of invasive dental procedures before tx

31
Q

4 conservative treatments of osteonecrosis of the jaw

A
  • pain control
  • debridement of necrotic bone
  • tx of infection
  • stop bisphosphonates (not much use once disease has begun)

Year 3 Human Disease (28 decks)

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