Palliative care Flashcards
what are the principles of palliative care
improve qol for patients and their families with a life threatening illness
through prevention and relief of suffering, early identification, impeccable assessment, treatment of pain and other problems
physical, psychosocial and spiritual
what does approaching the end of life
likely to die within 12 months
those facing imminent death and those with advanced, progressive, incurable conditions, general frailty
at risk of sudden death
life threatening conditions caused by sudden catastrophic events
what are the key themes for development
early identification of patients who may need palliation
advanced anticipatory care planning
care in last hours/days
delivery of effective and timely care
what structures have replaced the Liverpool care pathway
One chance to get it right
care for people in the last days and hours of life
what are the principles of good end of life care
open lines of communication anticipation care needs encouraging discussion effective MDT input symptom control preparing for death providing support for relatives before and after
what is generalist palliative care
part of routine care delivered by all health and social care professionals, at home, in care or in a hospital
what is specialist palliative care
can help people with more complex palliative care needs
what are some features of pain
can be multifactorial
more than one pain
background/ breakthrough/ incident pain
many causes
what are the features of bone pain
worse on pressure/ weight bearing
what are the features of liver pain
RIQ tenderness
what are the features of raised ICP
headache, worse lying down and in the morning
what is colic
intermittent cramping pain
what is neuropathic pain
Burning/shooting/tingling/jagging/altered
sensation
name some weak opioids
codeine, tramadol, dihydrocodeine
name some strong opioids
morphine, diamorphine, fentanyl, oxycodone
what does by the clock pain relief mean
analgesics should be given at regular intervals
what are some cautions for opioids
renal impairment, acute respiratory depression, elderly
however for terminal illness these should not necessarily rule out use of opioids
what are the most common side effects of opioids
nausea, vomiting, constipation, dry mouth, biliary spasm
opioid toxicity
what are the features of opioid toxicity
– Shadows edge of visual field – Increasing drowsiness – Vivid dreams / hallucinations – Muscle twitching / myoclonus – Confusion – Pin point pupils – Rarely, respiratory depression
what are the features of practical prescribing for morphine
controlled release for background pain relief
twice a day
also breakthrough pain relief as required
what must be prescribed for constipation during opioid use
stimulant and softening laxative
senna, bisacodyl, docusate
etc
what antiemetics can be prescribed for nausea associated with opioids
metoclopramide haloperidol (consider QT interval)
what can be prescribed for neuropathic pain
Amitriptyline/ Gabapentin/ Carbamazepine
what can be prescribed for liver capsule pain/ raised ICP
Steroids (dexamethasone)
what can be given for bowel/bladder spasms
buscopan (hyoscine butyl bromide)
why are smaller volumes of diamorphine needed
more water soluble than morphine
what is oxycodone
second line opioid
less hallucinations, itch, drowsiness, confusion
what is fentanyl patch
second line opioid lasts 72 hours use in stable pain use if oral/SC routes unavailable useful if persistant side effects with first line opioids
