Palliative care

Question 1

what is palliative care

Answer 1

doing everything possible to support someone’s quality of life in the context on an incurable illness - holistic care and symptom control

Question 2

what is ACP

Answer 2

advanced care plans - created by GPs and shared with other professionals in patients care eg. no resuscitation, no hospital admission ect.

Question 3

true or false: palliative care is for dying patients only

Answer 3

false

includes care of the dying by can be offered at any point from diagnosis

Question 4

where to find info on symptom management in palliative care

Answer 4

Scottish palliative care guidelines

Question 5

pain management step 1: mild pain treatment

Answer 5

paracetamol 1g 4x daily
and/or NSAID eg naproxen 500mg 2x daily
and/or other adjuvant

Question 6

pain management step 2: moderate pain

Answer 6

codeine 30-60mg 4x daily

and/or adjuvant

Question 7

pain management step 3: severe pain

Answer 7

stop codeine and switch to strong opioid - usually morphine

and/or adjuvant

Question 8

what is modified release morphine

Answer 8

12 hr preparation given in morning and at bedtime - manages background pain

MST or zomorph

Question 9

what opioid is used to manage breakthrough pain

Answer 9

immediate release morphine (taken as required)

oramorph (liquid) or sevredol (tablet)

Question 10

how do you calculate the breakthrough dose in comparison to the background dose

Answer 10

the background dose divided by 6

Question 11

what are some symptoms of opioid toxicity

Answer 11

hallucinations
vivid dreams
myoclonus - sudden jerking movements in sleep
drowsiness

Question 12

treatment for opioid toxicity

Answer 12

check renal function - impaired renal function can cause morphine toxicity

if decrease renal function seek advice and switch to a different opioid

if missed becomes respiratory depression

Naloxone is used to reverse morphine v quickly

Question 13

how is naloxone used to reverse opioid toxicity

Answer 13

dilute the naloxone and give in tiny doses until respiratory rate improves - otherwise all their pain will come back at once

Question 14

what is a second line strong opioid to morphine

Answer 14

oxycodone (twice as strong as morphine so dose needs halved)

Question 15

clues to tell you if someone is near the end of life

Answer 15

Worsening weakness and performance status

worsening physiological status with no reversibility

struggling to manage oral medicines

losing interest in food and fluid

sleeping more, eventually unconsciousness

Question 16

what are some treatable conditions which mimic dying

Answer 16

Opioid/drug toxicity 
Sepsis 
Hypercalcaemia 
AKI 
Hypoglycaemia

Question 17

things to ensure when the patient is dying

Answer 17

Only essential medications continued
Oral medications covered to alternative route if no swallow
Anticipatory medications prescribed for common problems
Don’t miss urinary retention as cause of agitation
Stop routine obs/monitoring/take out unused cannulas
Appropriate environment and equipment in place

Question 18

what are syringe drivers

Answer 18

give smooth delivery or meds via continuous subcutaneous infusion

infused over 24 hours and changed daily - portable

Question 19

what is the anticipatory prescription for pain and SOB in dying people

Answer 19

morphine 2mg scut

Question 20

what is the anticipatory prescription for distress and SOB in dying people

Answer 20

midazolam 3mg scut

Question 21

what is the anticipatory prescription for nausea in dying people

Answer 21

levomepromazine scut

Question 22

what is a just in case box

Answer 22

used for scut symptom control in peoples homes to prevent delays in symptoms relief