Palliative Care Flashcards
Which has a better survival rate? Ovarian or cervical cancer
Cervical cancer
Physical symptom burden of Gynae Malignancies
- N.V
- Pain
- Bleeding
- lethargy
- ascites
- constipation
rx related
EMotional symptom burden
- anxiety
- altered self image (uncertainty of fertility)
How common is N.V in advanced cancer pts?
- 70% has it
Important to ask pt about _____ with N & V?
- COMBINATIONS of drugs tried and routes used
What is succussion splash?
- listen over the stomach for liquid splashes
How is the cerebral cortex involved with N.v?
emotions sight smell raised ICP Anxiety
What centre in the brain is involved with motion sickness?
- vestibular centre
Where is the chemoreceptor trigger zone? And how may it trigger N.V?
METABOLIC disturbance (drugs, uremia and Ca)
Anti-emetic with chemotherapy?
odansetron
How does impaired gastric emptying present as?
- —-worse whenn they eat food—prevention of gastric fluids flowing through d.t gastric obstruction
- LARGE VOLUMES vomited
- no nausea, until they eat
- FEELS better after sick
Non- pharmicological management for N,V?
- mouth care
- ANTICiPATORY NAUSEA (d.t being constantly sick; expect to be nauseous)
- acupressure bands
- acupuncture
- encourage SMALL meals (AVOID being around food!)
Laxatives are given orally.
That hinders one from taking it when they are sick. What is an alternative?
- suppositories
What is IMPORTANT when prescribing drugs for N.V?
- ensure the drug you are giving can be ABSORBED
- —-ASK the patients if they can actually take their pills
What does brown vomitus suggest?
- coffee-brown: GI BLEED
- fecal matter
What is a commonn GI condition cancer pts have?
- MALIGNANT BOWEL OBSTRUCTION (2-50% in ovarian CA pts)
- –or obstruct. d.t HERNIA, adhesions, constipation
Diff. in complete and partial bowel obstruction.
- complete- NOTHING passes the obstruct
- PARTIAL —-20% passes through (NOT complete emptying of bowels)
Important to consider what for malignant bowel obstruction?
- gradual onset over weeks
When is a cancer patient not considered for surgery for MBO?
- IF they have MULTIPLE levels of obstruction
- —-drug management
When is a cancer patient not considered for surgery for MBO?
- IF they have MULTIPLE levels of obstruction
- —-drug management
What is involved in the management of MBO?
- NG tube down (brings up all the fluid up)
- NIL by mouth
- bowel rest
What are the AIMs of medically managing MBO?
-promote resolution (if partial obstruct.)
- relieve pain and colic
- reduce vomiting w.o using NG tube
- relive NAUSEA and thirst
- ahcieve hospital discharge
Anti-emitic (meta-clopromide—if no colicky pain)
What is the use of steroid in MBO?
- reduces the inflammation secondary
Buscopan
- slows bowl down
-
Octreotide
- POTENT reducer of GI secretions
Name drug options for N.V
Analgesics Anti-emetics (opioids/Hyoscine butylbromide) Steroids Anti-secretory agents Laxatives Fluids
