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3.1 Ageing > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

Who provides palliative care?

A

Hospices
Hospital
Community
Specialist palliative care services such as macmillan day care

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2
Q

Which types of patients may receive palliative care?

A 
Incurable cancers
Progressive organ failure (COPD, PF, heart failure, renal failure)
Progressive neurological disorders
Dementia
Frailty
Multimorbidity
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3
Q

What symptoms are usually controlled in palliative care?

A 
Pain
Fatigue/weakness
Poor mobility
Breathlessness
Poor appetite/wgt loss
Sore/dry mouth
N&V
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4
Q

List the steps of pain management

A

Step 1: Mild pain
Paracetamol and/or NSAID and/or other adjuvant
Step 2: Moderate pain
Codeine or co-codomol (codeine combined w/ paracetamol)
Step 3: Severe pain
Stop codeine and switch to strong opioid (usually morphine) Use in conjunction w/ paracetamol/NSAID/adjuvants

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5
Q

Is morphine addictive?

A

No if used solely for pain management and not used to achieve a feeling of ‘reward’

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6
Q

Can you get withdrawal symptoms from morphine?

A

Yes if suddenly stopped or reversed

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7
Q

What severe side effect can occur with morphine is not used correctly?

A

Respiratory depression

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8
Q

Which drug can reverse morphine very quickly?

A

Naloxone

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9
Q

What are symptoms of opioid toxicity?

A

Hallucinations, myoclonus and drowsiness

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10
Q

What are the two types of morphine?

A 
Modified release (MR)- background pain 
(Twice daily tablets)
Immediate release (IR)- breakthrough pain
(PRN tablet (sevredol) or liquid (oromorph)
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11
Q

How do you convert a dose of codeine to morphine?

A

Divide codeine dose by 10

E.g. codeine 60mg four times a day (240mg daily) becomes 24mg morphine equivalent

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12
Q

If a patient is taking 15mg of codeine four times a day, what would that convert to in MST and oramorph?

A

MST 5mg twice daily

Oramorph 2mg PRN

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13
Q

If a patient is taking MST 50mg twice daily what does that convert to?

A

Breakthrough dose= 100mg/ 6

=15mg oramorph

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14
Q

What does palliative care involve?

A

Pain and symptom control
Emotional and psychological support
Advanced care planning (helping to plan ahead)
Care of the dying patient

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15
Q

What is advance care planning? (ACP)

A

Thinking ahead to avoid crisis decision making near end of life

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16
Q

When admitting an elderly person to hospital you should always check their clinical portal for what>?

A

A Key Information Summary (KIS) which identifies patients with palliative care needs

17
Q

What does a Key Information Summary include?

A

Resusciatation wishes/decisions
Preferred place of care and death
Anticipatory/ ‘Just in Case’ medications
Power of Attorney

18
Q

What are recognisable signs of dying?

A

Worsening/weakness
Struggling to manage oral medicines
Losing interest in food/fluid
Sleeping more

19
Q

Which diseases can mimic the dying process?

A 
Hypoglycaemia
Sepsis
Delirium
Hypercalcaemia
Opioid/drug toxicity
AKI
20
Q

What changes should be made to medication in end of life?

A

Stop all non-essential medications (e.g. statins, anticoagulants)
Oral meds converted to alternative route (no swallow)
Anticipatory meds prescribed
Urinary retention could be a cause of agitation
Stop routine obs/monitoring

21
Q

What should oral routes be swapped for?

A

Syringe drivers (infused over 24 hours, up to 3 drugs at a time)

22
Q

How many times more potent is morphine when given SC?

A

Twice as potent when given SC

23
Q

How do you work out the SC dose of morphine from PO dose?

A

Divide PO dose by 2= SC dose

24
Q

If a patient is given oral MST 10mg bd, what is the SC dose?

A

SC morphine 10mg over 24 hours

25
Q

Which drugs are given as anticipatory drugs in end of life?

A

Pain/SOB- morphine
Distress - midazolam
Nausea- levomepromazine
Secretions- buscopan

26
Q

Why is buscopan given in end of life care?

A

It doesn’t cross the BBB

27
Q

How do you verify a death?

A

Check for spontaneous movement
Reaction to voice and pain
Palpate 2 major pulses for one minute
Inspect eyes for dryness, fixed dilated pupils, absence of corneal reflexes + clouding of cornea
Auscultate hearts and lungs
Notify funeral directors about pacemakers- can blow up in cremation
Record date + time

3.1 Ageing (4 decks)

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