Palliative Care

Question 1

What is the pain management ladder?

Answer 1

1. non-opioid +/- adjuvant
2. opioid for mild to moderate pain + non-opioid +/- adjuvant
3. opioid for moderate to severe pain +/- non-opioid +/- adjuvant

Question 2

Give an example of a non-opioid analgesic

Answer 2

paracetamol

Question 3

Give examples of adjuvants used to treat pain

Answer 3

NSAIDs 
amitriptyline 
pregabalin 
corticosteroids 
nerve block 
TENS 
radiotherapy

Question 4

Give an example of an opioid for mild to moderate pain

Answer 4

codeine

Question 5

Give examples of opioids for moderate to severe pain

Answer 5

morphine
diamorphine
oxycodone

Question 6

What must be co-prescribed with opioids for moderate to severe pain?

Answer 6

anti-emetics

laxatives

Question 7

What can cause death from head and neck cancer?

Answer 7

infection - pneumonia
issues related to hydration and nutrition
frailty and medical co-morbidities
difficult circumstances/emergency situations - airway problems/bleeding

Question 8

What is the first stage of dying?

Answer 8

at risk of dying in 6-12 months but may live for years
disease(s) relentless
progression is less reversible
treatment benefits are waning

Question 9

What is the second stage of the dying process?

Answer 9

2-9 moths to live
change underway
benefit of treatment less evident
harms of treatment less tolerable

Question 10

What is the third stage of dying?

Answer 10

short weeks - 1-8 weeks
recovery less likely
risk of death is rising

Question 11

What is the fourth stage of dying?

Answer 11

last days - 2-14 days
dying begins
deterioration is weekly or daily

Question 12

What is the fifth stage of dying?

Answer 12

last hours - 0-48hrs
actively dying
body is shutting down
person is letting go

Question 13

What is stridor?

Answer 13

sound on inspiration

Question 14

What does stridor signify?

Answer 14

large airways obstruction - trachea or main bronchus

Question 15

What is the management of stridor?

Answer 15

oxygen, steroids, heliox and decide on level of intervention 
ENT - tracheostomy 
respiratory - stenting or laser 
oncology - radiotherapy 
palliative medicine - active sedation

Question 16

What can cause major haemorrhage in cancer?

Answer 16

erosion of major artery

Question 17

What is the management of a major haemorrhage in palliative care?

Answer 17

resuscitation won’t work
plan ahead - review drugs, dark green towels (blood looks less dramatic against dark colours), crisis medication prescribed
large doses of midazolam IM or IV
someone stay with the patient at all times