Palliative Care Flashcards

1
Q

What physical symptoms do patients usually experience in gynaecological malignancies?

A
  • Pain
  • Nausea and Vomiting
  • Constipation
  • Bleeding
  • Treatment related (e.g. Chemotherapy)
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2
Q

What emotional and psycho-social symptoms may patients experience in relation to gynaecological malignancy?

A
  • Fear
  • Worry about future
  • Why me?
  • What will happen to my family?
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3
Q

What is the difference between nausea and vomiting?

A

Nausea - unpleasant feeling of the need to be sick, often with autonomic features

Vomiting - Forceful expulsion of gastric contents through the mouth

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4
Q

What do you need to ask in order to take an adequate nausea and vomiting history?

A
  • triggers?
  • volume
  • pattern
  • exacerbating and relieving factors
  • drugs tried + route
  • bowel habit
  • medication – contributing to the nausea and vomiting?
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5
Q

What must you be aware of if a patient is already on medication and is experiencing nausea and vomiting?

A
  • is drug contributing to nausea and vomiting?

- is drug being absorbed if patient is vomiting?

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6
Q

What are the 4 main reasons that a patient experiences nausea and vomiting?

A

Cerebral Cortext - emotions, sight, smell, raised ICP, anxiety
`
Vestibular Centre - motion sickness

GI Tract - distension, stasis, tumour mass, constipation

Chemoreceptor Trigger Zone - metabolic (uraemia, Ca), drugs

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7
Q

What drugs work to combat nausea and vomiting from the cerebral cortext and what receptors do these act on?

A

Dexamethasone, Benzodiazepines

NK1, 5HT (serotonin), ?GABA

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8
Q

What drugs work to combat nausea and vomiting from the vestibular centre and what receptors do these act on?

A

Cyclizine, Hyoscine

H1, ACh

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9
Q

What drugs work to combat nausea and vomiting from the GI tract and what receptors do these act on?

A

Metoclopramide, Levomepromazine, Ondansetron
5HT, D2, Ach
Caution in obstruction

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10
Q

What drugs work to combat nausea and vomiting from the Chemoreceptor trigger zone and what receptors do these act on?

A

Haloperidol, Ondansetron

D2, 5HT, Ach

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11
Q

How would you identify from a nausea and vomiting history that the patients symptoms are due to a cerebral cortex cause?

A

Clinical picture:
Vomiting worse in morning then gets better during day
Associated headache

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12
Q

What would cause impaired gastric emptying?

A
  • Locally advanced cancer
  • drugs
  • radiotherapy damage to gut
  • autonomic neuropathy
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13
Q

How would impaired gastric emptying present?

A
  • Not usually nauseated until patient eats
  • Then very nauseated
  • Large volume vomits
  • Feels better after being sick
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14
Q

What clinical picture would indicate a chemical or metabolic cause of nausea and vomiting?

A

Persistent nausea

Little relief from vomiting

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15
Q

What would cause a chemical or metabolic abnormality that stimulates nausea and vomiting?

A

Medication
advanced cancer
sepsis
kidney or liver impairment

Think: Ca, Na, Mg Urea

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16
Q

What non-pharmacological palliative care is provided to counteract nausea and vomiting in patients with gynaecological malignancies?

A
Mouth care 
Keep bowels moving (avoid constipation)
Small meals, rather than large meals
Avoid cooking or preparing food (due to smell)
Acupressure bands (for example Seaband®)
Acupuncture
17
Q

What is meant by malignant bowel obstruction?

A

Clinical evidence of bowel obstruction in the setting of a diagnosis of intra-abdominal cancer OR non-intra abdominal cancer with clear intraperitoneal disease

18
Q

Bowel obstruction in advanced cancer may not always be DIRECTLY due to the malignancy. What other causes are possible?

A

benign causes

Eg; Adhesions post-radiotherapy

19
Q

Why do patients with malignant bowel obstruction vomit?

A

Proximal accumulation of secretions

=> these need to be removed

20
Q

How do patients with malignant bowel obstruction usually present?

A
Nausea + Vomiting
Pain (Continuous or Colicky)		
Anorexia
Systemic symptoms from underlying cancer
Reduced then absent bowel motions/flatus
21
Q

How is malignant bowel obstruction managed?

A
  • Drip and suck’ before surgery
  • Bowel rest
  • Null by mouth

Surgical Resection
=> Palliative colostomy or ileostomy
OR Self expanding metallic stent

22
Q

What are the main aims of medical management of malignant bowel obstruction?

A
  • If partial => promote resolution with prokinetics
  • Relieve pain and colic
  • Reduce vomiting without use of NG tube
  • Relieve nausea
  • Relieve thirst
23
Q

What pharmacological options can be given for malignant bowel obstruction?

A
  • Analgesics => Opioids /Hyoscine butylbromide
  • Anti-Emetics => Metoclopramide if not contra-indicated and partial/subacute obstruction
  • Steroids => Dexamethasone to reduce inflammation (especially nodal that could be causing external obstruction)
  • Anti-secretory agents => Buscopan, Octreotide (CSCI)
  • Laxatives => Docusate or movicol to soften stool
  • Fluids
24
Q

Why is it important to remember to not given nauseated/ vomiting patients oral medication?

A

MUST BE ABSORBED

=> IV Subcutaneous, Transdermal, Intramuscular.