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AGEING > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What symptoms are often controlled in palliative care?

A
  • fatigue
  • nausea and vomiting
  • breathlessness
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2
Q

Why is communication so important in palliative care?

A
  • patients have a lot of questions
  • helps patients come to terms with the concept of palliative
  • families need to know what is going on with their relative (don’t assume that they KNOW)
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3
Q

How do all the different professionals involved in a patients care know the general aims and plans for the patient?

A

Electronic Advance Care Plans or ‘ACPs’

  • created by GPs and shared with other professionals
  • called a “Key Information Summary” or KIS
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4
Q

What conditions are most likely to require palliative care?

A

Cancer
Organ failure (e.g. RESP-COPD, Liver failure)
Progressive neurological disease (e.g. MND)
Frail patients with dementia

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5
Q

Describe the illness trajectories of Deterioration in Terminal Illness compared to Organ Failure and Frailty.

A

Deterioration in terminal illness

  • predictable decline
  • can happen relatively quickly (steep curve drop)

Organ Failure

  • exacerbations of disease create a “wave” like curve
  • this trajectory is often present until death

Frailty

  • low level of baseline function
  • deterioration often subtle
  • often over a long period of time
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6
Q

What other members are part of the palliative care team apart from Doctors/Nurses/AHPs?

A

Chaplains
Bereavement workers
Social Work
Community Palliative Nurses (e.g. MacMillan)

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7
Q

Describe the basic steps of the WHO pain ladder

A

MILD
- paracetamol
- NSAIDs
+/- aduvant

MODERATE
- codeine/ co-codamol
+/- adjuvant

SEVERE
- morphine
+/- paracetamol/NSAID/adjuvant

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8
Q

What are the two different types of pain that patients experience and how do we manage these differently?

A

Background
- managed with modified release preparations that last around 12 hrs in the body

Breakthrough
- managed with immediate release preparations that last around 4 hours in the body

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9
Q

What brands of Morphine are Modified Release (MR)?

A

MST Continus

ZoMorph

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10
Q

What brands of Morphine are immediate release?

A

Sevredol

Oramorph

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11
Q

How do we normally work out the dose to initiate patients on morphine?

A

Usually patients are on MAX. codeine in one day
i.e. 60mg QDS => 240mg

THIS IS EQUIVALENT TO AROUND 30mg MORPHINE

Split the dose of morphine into 2 for modified release preparation.
=> morphine 15mg M/R BD

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12
Q

How strong should the pain relief given for breakthrough pain be?

A

1/6 of the total daily dose of morphine

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13
Q

What are the common symptoms of opiate toxicity?

A
  • Hallucinations
  • Sudden jerking (myoclomus)
  • Drowsiness
  • can also cause respiratory depression
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14
Q

If a patient becomes opioid toxic, what should you check for?

A

Decreased renal function

- as morphine accumulates if renal function declines

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15
Q

What drug is used to reverse the effects of opioid toxicity, and how should it be used?

A

Naloxone can reverse morphine very quickly

=> must be used as a diluted preparation to treat opiate side effects like resp. depression

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16
Q

What other opioids can be used aside from morphine?

A

oxycodone

17
Q

Why does the dose need to change when swapping patients from morphine to oxycodone?

A

Oxycodone is 2x as strong as morphine

=> A patient on Morphine 10mg M/R BD
changes to Oxycodone 5mg M/R BD

18
Q

What signs are important to recognise that may indicate a patient is nearing death?

A
  • General weakness
  • Loss of swallow mechanism
  • Lose interest in food/fluids
  • Sleeping more often
19
Q

What conditions may mimic patients deteriorating which are actually reversible?

A
  • Opiate toxicity
  • Delirium
  • Sepsis
  • AKI
20
Q

How can we ensure patients are most comfortable at the end of life?

A
  • Stop inessential medications (statins)
  • Oral meds converted to alternative route if no swallow
  • Don’t miss urinary retention as a cause of agitation
  • Stop routine obs/monitoring/take out unused cannulas
  • Appropriate environment (e.g. side room) and equipment in place (e.g. if patient wishes to die at home)
21
Q

What route of delivery is often used for drugs if oral drugs are no longer tolerated?

A

continuous subcutaneous infusion (CSCI)

using a syringe driver

22
Q

What are the advantages of using a syringe driver to deliver medications?

A
  • can be used in home or community

- can mix 3 different drugs in syringe for delivery together

23
Q

Morphine delivered through a syringe driver infusion is weaker than if it is given orally. TRUE/FALSE?

A

FALSE

morphine given as a CSCI is 2x as strong as oroal morphine

24
Q

If patients are having to use immediate release morphine for breakthrough pain often during the day, how do we manage this?

A

Increase the background M/R dose

25
Q

What other drugs are given in palliative care for symptom control?

A

Midazolam - for distress
Levomepromazine - for nausea
Hyoscine Butylbromide (Buscopan) - for secretions

26
Q

What are “Just in Case” boxes?

A

Boxes kept in patients homes which are useful for symptom control in the community

27
Q

What can be given in patients are showing signs of dehydration in the final stages of life?

A

Trial of artificial hydration if patient is distressed due to dehydration
**SCUT/IV fluids not routinely used **

28
Q

Patients whose death was expected can have their death verified by a nurse working on the ward. TRUE/FALSE?

A

TRUE

29
Q

What checklist must a doctor complete before verifying a death?

A

Check for:

  • spontaneous movement (inc. respiratory effort)
  • reaction to voice and pain (sternal rub)
  • Palpate 2 major pulses for 1 min

Inspect the eyes looking for

  • dryness
  • fixed dilated pupils
  • absence of corneal reflexes
  • clouding of the cornea

Auscultate the heart and lungs for 1 min
NOTE pacemaker or other implantable device!! (cremation)

30
Q

When would a death need to be reported to the procurator fiscal?

A

e.g. mesothelioma => work related death

AGEING (11 decks)

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