Palliative Care Flashcards
What physical symptoms do patients usually experience in gynaecological malignancies?
- Pain
- Nausea and Vomiting
- Constipation
- Bleeding
- Treatment related (e.g. Chemotherapy)
What emotional and psycho-social symptoms may patients experience in relation to gynaecological malignancy?
- Fear
- Worry about future
- Why me?
- What will happen to my family?
What is the difference between nausea and vomiting?
Nausea - unpleasant feeling of the need to be sick, often with autonomic features
Vomiting - Forceful expulsion of gastric contents through the mouth
What do you need to ask in order to take an adequate nausea and vomiting history?
- triggers?
- volume
- pattern
- exacerbating and relieving factors
- drugs tried + route
- bowel habit
- medication – contributing to the nausea and vomiting?
What must you be aware of if a patient is already on medication and is experiencing nausea and vomiting?
- is drug contributing to nausea and vomiting?
- is drug being absorbed if patient is vomiting?
What are the 4 main reasons that a patient experiences nausea and vomiting?
Cerebral Cortext - emotions, sight, smell, raised ICP, anxiety
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Vestibular Centre - motion sickness
GI Tract - distension, stasis, tumour mass, constipation
Chemoreceptor Trigger Zone - metabolic (uraemia, Ca), drugs
What drugs work to combat nausea and vomiting from the cerebral cortext and what receptors do these act on?
Dexamethasone, Benzodiazepines
NK1, 5HT (serotonin), ?GABA
What drugs work to combat nausea and vomiting from the vestibular centre and what receptors do these act on?
Cyclizine, Hyoscine
H1, ACh
What drugs work to combat nausea and vomiting from the GI tract and what receptors do these act on?
Metoclopramide, Levomepromazine, Ondansetron
5HT, D2, Ach
Caution in obstruction
What drugs work to combat nausea and vomiting from the Chemoreceptor trigger zone and what receptors do these act on?
Haloperidol, Ondansetron
D2, 5HT, Ach
How would you identify from a nausea and vomiting history that the patients symptoms are due to a cerebral cortex cause?
Clinical picture:
Vomiting worse in morning then gets better during day
Associated headache
What would cause impaired gastric emptying?
- Locally advanced cancer
- drugs
- radiotherapy damage to gut
- autonomic neuropathy
How would impaired gastric emptying present?
- Not usually nauseated until patient eats
- Then very nauseated
- Large volume vomits
- Feels better after being sick
What clinical picture would indicate a chemical or metabolic cause of nausea and vomiting?
Persistent nausea
Little relief from vomiting
What would cause a chemical or metabolic abnormality that stimulates nausea and vomiting?
Medication
advanced cancer
sepsis
kidney or liver impairment
Think: Ca, Na, Mg Urea