Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

oncoloy > palliative care > Flashcards

palliative care Flashcards

1
Q

what are the two subcategories of palliative care?

A

supportive care - control symptoms and although the person will eventually die from the condition the aim is to prolong their life and maximise quality

end of life care - those who are likely to die within the next 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are examples of those in end of life?

A

acute condition where death is imminent

advanced progressive incurable conditions

general frailty and comorbidities

a risk of a sudden crisis in an existing condition e.g. parotid tumour eroding into carotid artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what do end of life patients want from you?

A

dignity - nice environment and honesty

optimal symptom control and to be made comfortable - out of hours support, advanced prescription, regular reviews. Because comfort is the main concern stop unnecessary treatment e.g. LMWH

allowed to make choices

psychological, social and spiritual support

support for their families

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

why is it important end of life is delt with correctly?

A

otherwise it can cause complex bereavement issues and formal complaints.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the Liverpool care pathyway?

A

a pathway to aid clinicians in ensuring completeness and consistency of end of life care.. involves:

  • recognising the approach of death
  • assess psychological state and capacity
  • spiritual support for patient and family
  • prescribing
  • management of symptoms
  • MDT for decisions and communicate with primary/ secondary care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is meant by a holistic approach in palliative care?

A

look beyond the diagnosis and consider the patients psychological, social, spiritual and physical needs. the aim is to make quality of life top priority rather than prolonging life unnecessarily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

list the different people involved in the multidisciplinary approach in palliative care

A 
Macmillan nurse
Doctors
Hospice staff - nurses and doctors
psychologists/ counsellor 
physiotherapist
occupational therapist
social workers 
chaplin (church)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the role of a macmillan nurse?

A

visits patients and families, gives advice and directs them to the correct place and offers psychological support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the role of a social worker ?

A

assessment of needs
financial issues - e.g. wills
looks at family dynamics and helps advice how to break bad news to children
deals with family complications e.g. if patient is a carer for someone else
lasting power of attorney put in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the role of a physiotherapist

A

breathing techniques to reduce anxiety and improve breathing/ coughing
mobility - e.g. walking aids? able to get out of bed?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the role of an occupational therapist?

A

to help with additional equipment needs e.g. commode.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the role of a counsellor in palliative care?

A

works with whole family after death

helps guide patient on how to tell children and offers support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the role of a doctor in palliative care?

A

prescribe and review medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

wha is the role of a hospice?

A

control symptoms and make patient comfortable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

why do some people find a chaplin useful?

A

some people have faith and want to speak to chaplin before they die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the physical clues to recognise a dying patients

A 
profoundly weak 
gaunt 
drowsy
disorientated
reduced oral intake and difficulty taking oral meds
cool peripheries 
skin colour changes
abnormal breathing pattern 
poor concentration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

list the different symptoms that need to be managed in palliative care

A 
pain 
N&V
breathlessness
respiratory secretions
anxiety/ restlessness and agitation
etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are anticipatory prescriptions?

A

in end of life patients we anticipate that symptoms could occur at some point and thus doctors prescribe things in anticipation such that nurses can give these medications when the patient starts to complain of such symptoms

e.g.
Pain - morphine 2.5-5mg s/c PRN or equivalent oral
N+V - haloperidol 1.5mg s/c PRN or levomepromazine
breathlessness - midazolam 2.5-5mg s/c PRN or morphine 2.5-5mg s/c PRN
restlessness and agitation - midazolam or haloperidol
respiratory secretions - glycopyroniunm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

why are communication skills key to palliative medicine?

A

breaking bad news
discussing diagnosis and treatments
eliciting concerns and listening to patients concerns
discussing options for end of life and difficult conversations such as DNACPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

why is it important to manage pain in cancer patients?

A

pain is unpleasant for the patient
pain causes anxiety - ‘if im in pain now, what will death be like’
pain impairs other functions - shallow breaths leading to secretions and chest infections. reduces mobility

majority of advanced cancer patients are in pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the causes of pain in cancer patients?

A 
the cancer
anticancer treatment 
concurrent disorder
cancer related debility e.g. hydronephrosis from compression of ureters 
emotional distress and lack of support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what type of pain do cancer patients suffer from?

A

can be nociceptive, neuropathic, a combination.

because they may have long standing pain, there may also be an element of central sensitisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is meant by total pain?

A

physical pain and emotional pain and any other contributor of pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is pain managed?

A

WHO analgesic ladder + adjuvants.

most advanced cancer patients are on strong opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the different forms of morphine?

A

immediate release (IR) - given PRN
- oromorph - liquid 10mg/5ml, 100mg/5ml
- sevredol - tablets 10,20,50mg
slow release - SR - continuous to prevent pain
- zoromorph capsules BD
- morphine sulphate tablets BD
- 24 hour continuous syringe driver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how do we titrate opioid doses up?

A

find total daily dose (TDD) usually total of last 24 hour PRNs and continuous dose.
then divide by 2 for new Slow release
then divide by 6 for new PRN dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how is oral morphine converted to subcutaneous?

A

divide by 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what dose of oral morphine is usually used to begin with?

A

2.5-5mg

29
Q

how is oral codeine converted to oral morphine?

A

divide by 10

30
Q

how is oral morphine converted to subcutaneous diamorphine?

A

divide by 3

31
Q

what are the causes of nausea and vomiting in cancer patients?

A 
cancer itself
treatment of cancer - opioids, chemotherapy, radiotherapy (chemo induced NandV can be anticipatory)
specific examples 
   - impaired gastric emptying 
   - chemical / metabolic changes
   - raised ICP
   - constipation 
   - oral thrush 
   - uraemia 
   - infection
   - malignant bowel obstruction
32
Q

what can impair gastric emptying in cancer patients? what symptoms will this cause?

A

locally advanced cancer, liver metastasis, ascites, morphine and anticholinergics.

reduced appetite, epigastric discomfort, bloating and intermittent vomiting

33
Q

what can cause metabolic/ chemical changes in cancer patients? how will these patients present?

A

drugs (opioids, SSRIs, Abx)
hepatic, renal failure
sepsis
tumour toxins

nausea, aggravated by sight and smell of food.

34
Q

what are the causes of raised ICP in cancer patients?

A

brain metastasis, haemorrhage, meningeal disease

35
Q

what causes constipation in cancer patients?

A

drugs (opioids), hypercalcaemia, immobility, reduced nutrition/ hydration, malignant obstruction

36
Q

what are the risk factors for chemotherapy induced nausea and vomiting?

A

female, <50 yrs , previous history e.g. pregnancy or motion sickness, specific chemoagents.

37
Q

what are the consequences of nausea and vomiting in cancer patients?

A 
dehydration 
anxiety 
debilitating 
malnutrition 
electrolyte disturbance
38
Q

how is nausea and vomiting in cancer patients managed?

A

regularly assess and treat any reversible causes e.g. PPIs for gastritis, bisphos for hyperCa

non pharm - small meals, reduce anxiety, low fat

depends on cause:

  • impaired GI emptying - levomepromazine/ domperidone
  • radiotherapy - haloperidol or odansetron
  • chemical/ metabolic - haloperidol
  • intracranial - cyclizine and dexamethasone
39
Q

what durgs are most commonly used for nausea and vomiting in cancer patients?

A

haloperidol or levomepromazine

can prescribe these in anticipation

40
Q

what are the causes of breathlessness in cancer patients?

A 
tumour obstructing airways - lung cancer
pleural effusion - lung cancer
SVC obstruction 
ascites 
anxiety 
phrenic nerve palsy 
weakness and fatigue
treatment related - lobectomy, radiotherapy, chemo
infection 
P.E 
rib metastasis
anaemia
41
Q

how is breathlessness treated?

A

treat specific cause - drain pleural effusion/ ascetic fluid drainage, heart failure/ P.E/ infection

non pharm - fan on face (stimulates trigeminal nerve and sensation is interpreted as air entering lungs) , positioning (sit up), physio/ breathing techniques, CBT/ anxiety reduction

pharm:
- salbutamol
- small dose opioids (2.5mg -5mg) - reduces respiratory drive and sensation of breathlessness.
- benzo - reduces anxiety (midazolam/ lorazepam)
- steroids - reduces tumour oedema and may improve breathlessness
- oxygen

42
Q

are respiratory secretions during dying uncomfortable for the patient?

A

no not usually but can be distressing for the family

43
Q

how can respiratory secretions be managed?

A

change patient position
prescribe glycopyrronium (in anticipation)
give glycopyrronium SC and PRN when symptoms start
sometimes may use suction
stop IV fluids

44
Q

what is an alternative to glycopyrronium ?

A

hyoscine hydrobromide - however this is sedative and can cause confusion

45
Q

how is restlessness and agitation managed in end of life patients?

A

human presence can help
explore their spirituality - often seeing a chaplin can calm them
support their family and friends
prescribe anticipatory midazolam
consider underlying cause - pain, urinary retention, constipation, breathlessness etc

46
Q

what medications would you use for anxiety in comparison to delirium?

A

midazolam for anxiety

haloperidol / levomepromazine for delirium

47
Q

how is constipation managed in palliative patients?

A

encourage mobilisation if possible
increase oral intake
laxative - usually stimulants

48
Q

what are the causes of cough in cancer patients ?

A

lung cancer

chemo/ radiotherapy

49
Q

how is a cough in cancer patients managed?

A

positioning and physio
simple linctus - reduces coughing by coating pharynx
opioids supress cough stimulus

50
Q

what are the causes of diarrhoea in end of life patients and how can it be treated?

A 
infection
chemo
radio
antibiotics
laxatives 
overflow from constipation

treat cause , can give loperamide

51
Q

why is dry mouth common in end of life patients?

A

anticholinergics, chemo and radio and dehydraton

chemo/radio can cause mucositis making the mouth vulnerable to infection (usually given prophylactic fluconazole)

52
Q

how is dry mouth in end of life patients managed?

A

treat any thrush - fluconazole/ nystatin spray

good oral hygiene, mouth wash, saliva substitutes

53
Q

what is cachexia?

A

loss of muscle mass and fat due to increased metabolic demands in advanced cancer
poor prognostic factor
often accompanied by low appetite

54
Q

how can we treat/ help with cachexia?

A

nutritional support
steroids can improve appeptite but can add to muscle wasting

IV / SC fluids
NGT for fluids/ foods
PEG or IV feeding

55
Q

when are fluids/ nutritional support withdrawn?

A

when it is clear the patient is dying and in their final hours.
this is important because fluid withdrawal can reduce respiratory secretions and pulmonary/ cerebral oedema and make dying more comfortable.

56
Q

how can we help with lymphoedema?

A

tissue massage
compression bandages
skin care can help

57
Q

if a patient refuses treatment, how should this be dealt with?

A

capacity should be assessed

if a patient has capacity:

  • doctor and patient assess the situation
  • doctor recommends a particular option but no pressure put on patient
  • patient weighs up benefits and risks
  • agreement is made based on patients best interest.
58
Q

what things should be put into place before a patient deteriorates such that important decisions are known.

A

DNA-CPR
advanced discussion to refuse treatment before patient looses capacity e.g. often discussed with the patient if they want to go to hospital if something was to happen or if they just want to be made comfortable.

59
Q

what happens if the patient does not have capacity and a decision is needed?

A

doctor makes decision in patients best interest

there may be a lasting power of attorney

there may be advanced decisions to refuse treatment been put in place previously

60
Q

what structure do we follow to break bad news?

A

SPIKES

  • setting
  • perception
  • invitation
  • knowledge
  • emotions
  • strategies and summary
61
Q

how do we ensure there is a good setting for BBN?

A

private room
avoid interruption
appropriate introduction
before going in ensure you have all the background information and there are tissues.

62
Q

how can we assess a patients perception before BBN?

A

what do you make of the illness/ situation so far?

63
Q

How can we invite the patient to the BBN?

A

would you like me to tell you the details of the prognosis or are you someone who prefers not to know?

64
Q

How should knowledge of bad news be delivered?

A

use warning shots ‘ unfortunately things have got worse’
pauses
information given
treatment plan given
prognosis can be given in a vague way - ‘ I cant be certain but I can tell you that it will be months rather than years’
SLOW

65
Q

how are the patients emotions addressed after BBN ?

A

address with empathy
lots of pauses
‘ what are your main concerns? what are you thinking/ feeling?’
‘I cant begin to imagine what you must feel like, can you run me through some of your thoughts at this point’

66
Q

how do we summaries after BBN?

A

reassure them that you will do anything to support/ make them comfortable
explain what happens next for them and family

67
Q

list examples of controlled drugs?

A

opioids
midazolam
ketamine

68
Q

what additional tests should be done for those individuals on steroids?

A

BM testing once a day for 3 days and then once a week

because steroids can make sugars rise

69
Q

How is death verified

A

No pulse , heart sounds or resp effort and check for 2 mins

Pupils fixed and dilated

Unresponsive

oncoloy (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions