Palliative care Flashcards
6 categories of palliative care patients
- Incurable cancer
- Progressive organ failure
- Progressive neurological disorders
- Dementia
- Frailty
- Multimorbidity
what is step 1 of pain management?
Paracetamol and/or NSAID
What is step 2 of pain management?
Codeine or co-codomol
and/or adjuvant
What is step 3 of pain management?
STOP codeine
Switch to strong opiod
with paracetamol/NSAID/Adjuvant
If there is renal failure you avoid opioids as they can accumulate. What do you use instead?
Fentanyl
TRUE/FASLE
The highest dose of codeine=lowest dose of morphine
TRUE
The pathway for morphine for pain relief and reward are the same TRUE/FALSE
FASLE
TRUE/FASLE
Morphine is always addictive
FALSE
Not addictive is used judiciously
3 SE of morphine
Constipation
N&V
Respiratory depression
What drug reverses the effect of morphine?
Naloxone
What are the symptoms of opiod toxicity?
Hallucinations
Air plucking
Myoclonus
Drowsiness
How do you convert from the dose of morphine to codeine?
Morphine= Codine/10
TRUE/FALSE
The dose for breakthrough pain of morphine is often 5X the background dose
FALSE
1/6th of the background dose
What are treatable conditions that may mimic the dying process?
Sepsis Delirium Hypoglycaemia AKI Opiod/drug toxicity Hypercalcaemia
Anticipatory medication for PAIN/SOB
Morphine
Anticipatory medication for Distress?
Midazolam
Anticipatory medication for nausea?
Levomepromazine
Anticipatory medication for secretions?
Buscopan
What is a common cause of agitation?
Urinary retention
TRUE/FALSE
Morphine is 2x as potent when given submit therefore to convert to shrine driver /2
TRUE
What does the doctor have to check before they can verify death?
Spontaneous movement Reaction to voice/pain Pulse Eyes Heart/Lungs
TRUE/FALSE
You cannot be used for anatomical dissection if you have had a post-mortem
TRUE
When should a report be made to the Procurator Fiscal?
Sudden Unexplained Suspicious Suicide/neglect Drug related <18 and in care infectious disease that's a public health risk Under MHA at time of death
Registration of death is required by law within how many days of the death?
8 days
When is advanced registration allowed?
Religious/Cultural reasons
Practical- buried abroad
Compassionate- death <16
Who issues the “medical certificate of cause of death”
Registered medical professional
Who issues the “registration of death”
Registrar
What percentage of deaths have a level 1 review?
10% of deaths
How quickly are level 2 reviews completed?
3 working days
What is in part a of the mccd?
details of deceased
What is in part b of MCCD?
Details of certifying doctor
WHAT is in part c of MCCD?
Cause of death
What are the subparts of part c of the MCCD?
1a- Condition leading directly to cause of death
1b,c,d- Antecedent causes
II- Other significant conditions contributing to death but NOT to the disease causing it
What Is in part d of the MCCD?
Hazards inc pacemakers
What is in part e of the MCCD?
Additional information
What are MCCDs used for?
Designing public health services and prioritising areas for medical research and healthcare
TRUE/FALSE
Grief is solely to do with death
FALSE
It is an intense sorrow
Can be to do with a change in job, relationship, income etc
What are the 5 stages of grief?
Denial Anger Bargaining Depression Acceptance
