Palliative Care Flashcards
Name three major problems that patients in palliative care experience
Constipation
Pain
Nausea and vomiting
What are the non pharmacological and pharmacological management options of breathlessness in a patient in palliative care?
Non pharmacological: reassurance, relaxation techniques, breathing retraining
Pharmacological: 5-10mg MR oramorph (twice daily)
prescribe concurrent laxative/anti emetic
Benzodiazepines: use only in breathlessness associated with acute panic attacks/anxiety or if patient is imminently dying (500mg lorazepam)
Oxygen therapy
What are the reversible causes of constipation in palliative patients?
hypercalcaemia
fluid depletion
side effects of medications
What is the pharmacological management of constipation?
1) increase fluids, fruit juices
is stool hard or soft?
hard stool = 1) softener = sodium docusate
soft stool = 1) stimulant = senna
if this hasn’t worked, combine docusate + senna and PR exam
if on PR exam, if;
stool is soft and impacted = bisocodyl
stool is hard and impacted = glycerin suppositories
no stool = high phosphate enema
give examples of stimulant laxatives, their mechanism of action and the dosing
senna and bisocodyl
reduces bowel transit time - stimulant
15-30mg at night
give examples of osmotic laxatives, their mechanism of action and the dosing
macrogols = movicol
lactulose
retain water in gut lumen which encourages peristalsis
1-3 sachets daily
what are the S.E. of lactulose?
bloating
flatulence
abdominal pain
what are the different laxative enemas you can use?
arachis oil
microlax
phosphate
all are softener enemas
what are the reversible causes of nausea and vomiting in palliative care?
constipation
hypercalcaemia
medication side effects
what is the non pharmacological management of nausea and vomiting in palliative care?
provide a calm environment away from where food is prepared
make sure the meals are small and palatable
offer cool, fizzy drinks
consider parenteral hydration
complementary therapies: relaxation techniques
if nausea and vomiting is caused by medication, what anti-emetics would you give?
1) haloperidol
2) levomepromazine
(you can tell it is caused by medication as the nausea will be unrelenting, not relieved by vomiting)
if nausea and vomiting is caused by gastric stasis, what anti-emetics would you give?
metoclopramide or domperidone
if nausea and vomiting is caused by chemotherapy or radiotherapy, what anti-emetics would you give?
acute: ondansetron
delayed: levomepromazine
if nausea and vomiting is caused by organ damage, what anti-emetic should you give?
cyclizine
if nausea and vomiting is caused by raised intracranial pressure, what anti-emetic should you give?
cyclizine