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CSB092 > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What are the three truths about dying?

A
  1. we dont really mind death
  2. our biggest loss is emotional
  3. our biggest hope is spiritual
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2
Q

Why are we afraid of death?

A
  • in the last 100 years we have quarintiened death
  • people are now taken to a hospital and a sheet placed over them when they die and then to make sure they are gone they are cremated
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3
Q

Why is death good?

A
  • when people get old they lose all function and cannot live by themselves and thus are misserable
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4
Q

What are the ECOG ratings?

A 
0 = fully active
1 = restricted in physically strenuous activity
2 = self care but only for 50% of day
3 = limited self care for less then 50% of the day
4 = completely disabled
5 = dead
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5
Q

What happens in the last week of life?

A
  • weakness and fatigue
  • lack of appetite
  • lack of interest in surroundings
  • pain
  • restlessness and confusion
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6
Q

What happens in the last hours of life?

A
  • all die of circulatory failure
  • brain, kidney, liver and skin
  • the end is more distressing for the family than the patient
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7
Q

Define death?

A
  • abscence of life
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8
Q

What is medical death?

A
  • absent pupil reflex
  • no pulse, respiration
  • no brain activity
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9
Q

What are the considerations of the person?

A
  • social
  • ethical
  • health
  • financial
  • personal
  • other
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10
Q

Define palliative care

A
  • to cure sometimes, to relieve often, to comfort always

- easing the severity of pain associated with disease or illness without removing the cause

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11
Q

What are some factos associated with pallliatice care?

A
  • affirms life and treats dying as a normal proccess
  • neither hastens nor postpones death
  • provides relief from pain and other distressing symptoms
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12
Q

What does palliative care integrate?

A
  • physical, psychological, social, emotional and spiritual aspects of care with coordinated assessment and management of each person’ needs
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13
Q

What are the generalised effects of cancer?

A
  • weakness
  • fatigue
  • weight loss
  • increasing pain
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14
Q

What are the specific effects of cancer?

A
  • pain
  • bleeding
  • swelling
  • blockage
  • metabilc e.g. raised calcium
  • mass effects
  • fungating wound
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15
Q

What are the effects of morphine?

A
  • drawsiness and impaired concentration
  • constipation
  • nausea and vomitting
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16
Q

What is temporal effects?

A
  • patient feels fine now but later on feeling severly worse
17
Q

What are other factors to consider in palliative patient care?

A
  • prognosis
  • bucket list
  • advanced directives
  • financial planning
  • special events
  • funeral planning
18
Q

What is the role of RT in palliative care?

A
  • make you feel better but RT can make you feel worse first

- need to think about patient shouldn’t just treat for the sake of treating

19
Q

What are the aspects to decide if RT is used for palliative patient?

A
  • will RT help
  • prognosis (if patient is going to die tomorrow then dont treat)
  • patient factors
  • alternatives (e.g. is a stent possible instead of 10 days of RT)
  • timing
  • dose fractionation
20
Q

What are some indications of SC compression?

A
  • pain increasing
  • weakness
  • bladder and bowel dysfunction
21
Q

What is the RT role in SC compression?

A
  • 1 to 10 days
  • 80:20 rule
  • side effects: nausea and fatigue
22
Q

What happens in an emergency SC compression?

A
  • rapid onset of symptoms leading to irreversible paralyss
  • early intervention allows for preservation of neruological function in up to 80% of people
  • reduces pain
23
Q

What is the managmenet of an emergency SC compression?

A
  • steroids
  • emergency RT to 30Gy in 10 fractions
  • pain management
24
Q

What are the challenges in treating CNS?

A

PHYSICAL
- pain, confusion, immobility, neurological, other cancer effects (steroids, morphine)

EMOTIONAL
- drug effects, depression, cycle of loss, anger, fear

SPIRITUAL
- faith or lack of faith, miracles

PRACTICAL
- mask, timing of treatment, family, conflicitng interests, swelling from steriods

25
Q

What are the beam arrangment options for spine RT?

A
  • ant and post

- 2 post oblique, 1 lat, 1 ant oblique and 1 ant

26
Q

What are the common side effects from RT and how are they treated?

A
  • nausea: zofran
  • diarhhoae: gastro-stop
  • burning: skin lotion
  • muscositis: opioids
  • hair loss: none
  • fatigue: none
  • oesophagitus: mylanta
27
Q

How do we manage palliative patients?

A
  • empathy
  • allow space
  • understand journey: changes will occur
  • faimly members are also experiencing loss so may be part of care process
28
Q

What are the emotions realted to dying?

A
  • fear
  • guilt
  • loss and grief
  • hope
29
Q

What are the three factors that make up the “whole person”

A
  • physical
  • spiritual
  • emotional
30
Q

What are the 5 stages of emotion?

A
  • fear
  • anxiety
  • guilt
  • loss and grief
  • hope

CSB092 (9 decks)

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