Palliative Care

Question 1

Which has a better survival rate? Ovarian or cervical cancer

Answer 1

Cervical cancer

Question 2

Physical symptom burden of Gynae Malignancies

Answer 2

• N.V
• Pain
• Bleeding
• lethargy
• ascites
• constipation
  rx related

Question 3

EMotional symptom burden

Answer 3

• anxiety

- altered self image (uncertainty of fertility)

Question 4

How common is N.V in advanced cancer pts?

Answer 4

• 70% has it

Question 5

Important to ask pt about _____ with N & V?

Answer 5

• COMBINATIONS of drugs tried and routes used

Question 6

What is succussion splash?

Answer 6

• listen over the stomach for liquid splashes

Question 7

How is the cerebral cortex involved with N.v?

Answer 7

emotions
sight
smell
raised ICP 
Anxiety

Question 8

What centre in the brain is involved with motion sickness?

Answer 8

• vestibular centre

Question 9

Where is the chemoreceptor trigger zone? And how may it trigger N.V?

Answer 9

METABOLIC disturbance (drugs, uremia and Ca)

Question 10

Anti-emetic with chemotherapy?

Answer 10

odansetron

Question 11

How does impaired gastric emptying present as?

Answer 11

• —-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

Question 12

Non- pharmicological management for N,V?

Answer 12

• mouth care
• ANTICiPATORY NAUSEA (d.t being constantly sick; expect to be nauseous)
• acupressure bands
• acupuncture
• encourage SMALL meals (AVOID being around food!)

Question 13

Laxatives are given orally.

That hinders one from taking it when they are sick. What is an alternative?

Answer 13

• suppositories

Question 14

What is IMPORTANT when prescribing drugs for N.V?

Answer 14

• ensure the drug you are giving can be ABSORBED

- —-ASK the patients if they can actually take their pills

Question 15

What does brown vomitus suggest?

Answer 15

• coffee-brown: GI BLEED

- fecal matter

Question 16

What is a commonn GI condition cancer pts have?

Answer 16

• MALIGNANT BOWEL OBSTRUCTION (2-50% in ovarian CA pts)

- –or obstruct. d.t HERNIA, adhesions, constipation

Question 17

Diff. in complete and partial bowel obstruction.

Answer 17

• complete- NOTHING passes the obstruct

- PARTIAL —-20% passes through (NOT complete emptying of bowels)

Question 18

Important to consider what for malignant bowel obstruction?

Answer 18

• gradual onset over weeks

Question 19

When is a cancer patient not considered for surgery for MBO?

Answer 19

• IF they have MULTIPLE levels of obstruction

- —-drug management

Question 20

When is a cancer patient not considered for surgery for MBO?

Answer 20

• IF they have MULTIPLE levels of obstruction

- —-drug management

Question 21

What is involved in the management of MBO?

Answer 21

• NG tube down (brings up all the fluid up)
• NIL by mouth
• bowel rest

Question 22

What are the AIMs of medically managing MBO?

Answer 22

-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)

Question 23

What is the use of steroid in MBO?

Answer 23

• reduces the inflammation secondary

Question 24

Buscopan

Answer 24

• slows bowl down

-

Question 25

Octreotide

Answer 25

• POTENT reducer of GI secretions

Question 26

Name drug options for N.V

Answer 26

Analgesics
Anti-emetics (opioids/Hyoscine butylbromide) 
Steroids
Anti-secretory agents 
Laxatives 
Fluids