Palliative Care Flashcards
How to certify death - how do you confirm a patient’s death?
CHECK RESUS STATUS - if uncertain CPR
- ask ward staff about circumstance, read notes
- to family introduce yourself, offer condolences, explain you need to confirm and ask the family if they want to be present or not
- confirm identify - wrist label
- general inspection
- respiratory effort
- verbal stimuli
- pain response
- pupils
- central carotid pulse
- heart sounds 2 minutes
- respiratory sounds 3 minutes
DOCUMENT CLEARLY
What is cyclizine used for?
Motion sickness, anti-emetic
It is an antihistamine
What is prochlorperazine?
An antipsychotic, used in treatment of schizophrenia, first gen
What is promethazine?
A sedating antihistamine along with chlorphenamine
What does off-licence mean?
This is the use of a medication for a different purpose than intended. For example, using morphine to reduce coughing and breathlessness instead of for pain.
What is an unlicenced medication?
A medicine without marketing authorisation that cannot be sold in the UK.
What can be given to suppress a cough in a palliative patient?
Opiates - codeine, morphine, methadone
What can be given to patients to encourage a cough?
Physiotherapy
NaCl 0.9% nebuliser
Give 5 symptoms that are commonly treated in palliative care.
Cough Dyspnoea Pain Nausea and Vomiting Bleeding
What can be given to reduce bleeding risk in palliative cancer patients?
Discontinue anticoagulation
Transexamic acid for minor or moderate bleeds
Major bleeds are usually predicted, often little can be done, midazolam to reduce anxiety and fear
Give some physiological causes of nausea.
GI: dopamine, seratonin, can be caused by constipation, obstruction, infections
Brain: dopamine, seratonin, raised ICP
Vomiting Centre - ACh, H2, 5HT3
Medication (chemo, morphine), hypercalcaemia, hypomagnesia, uraemia
Give five anti-emetics and the situation they are best used in.
Domperidone - nausea caused by gastric problems
Hyoscine butylbromide - antimuscarinic, used for GI spasms
Cyclizine - antihistamine, used for vestibular vauses
Ondansetron - 5HT3 antagonist, used for medication induced nausea
Haloperidol - works in metabolic induced nausea
What are the steps of the analgesic pain ladder?
Paracetamol NSAIDs Alternatives: Gabapentin, Amitryptylline, Pregabalin Weak Opioids Strong Opioids
What are some contraindications and side effects of NSAIDs?
Not to be used in history of GI bleeding or ulcers, asthma, heart disease or renal disease.
Can cause renal impairment, GORD, ulcers (give PPI if long-term use)
What strength is codeine relative to morphine?
1/10th, as is tramadol
A patient’s PO morphine is adjusted to be SC. What needs to be done to the dose when this happens?
PO morphine is half as potent as IV morphine, so changing to PO means the dose needs to be halved.
What are some common side effects of opioids?
Nausea
Drowsiness
Constipation
A gentleman with a syringe driver is suffering from bowel colic. What drug helps?
Hyoscine butylbromide
Hyosceine hydrobromide is used in respiratory secretions
What can be used for metastatic bone pain?
Analgesia, bisphosphonates and radiotherapy
Which opioids are preferred in patients with renal disease?
Alfentanil
Buprenorphine
Fentanyl
How much breakthrough pain relief should be prescribed?
Usually 1/6th of their daily morphine dose
What are the advantages and disadvantages of a syringe driver?
Advantages: increased comfort, control of multiple symptoms, increased independence and mobility
Disadvantage: can only be used by trained staff, lack of flexibility with prescriptions, inflamed injection sites
What clinical features are seen in spinal cord compression?
Back pain
Weakness/Parasthesia/Numbness
Inability to control bladder o bowel
What is SVCO?
Superior Vena Cava Obstruction - occurs due to a tumour involving mediastinum or lung
Give 5 features of SVCO
Facial swelling Redness Vein/Artery swelling, distension or pulsation Breathlessness Periorbital oedema
How do you manage someone with SVCO?
Steroids - Dexamethason 16mg
What neutrophil count is worrying and why?
<1.0 and a temperature of >38
Febrile neutropenia/Neutropenic sepsis
What is your immediate treatment of hypercalcaemia?
IV fluids
Later IV bisphosphonates
A patient presents with pin-prick pupils, reduced SpO2, confusion and low GCS, what is the most likely drug causing this?
Opiates
What do you give in an opiate overdose?
Naloxone 400 microgram STAT
What are the 5 priorities in the care of the dying?
Recognition Communication Involvement - of family and dying person in decisions People important to the dying person Compassionate care + dignity
