Palliative Care Flashcards
ACP
Advanced Care Plan - voluntary conversation and opportunity to patient to plan (w or w/o family) their future care whilst they still have capacity
ADRT
advanced decision to refuse treatment
Which supersedes the other - LPA or ADRT
If the ADRT is made before the LPA, then the LPA supersedes. If the ADRT is made after the LPA, it is a legally binding document
cheyne-stokes breathing
rapid breathing then period of apnoea, can be sign of dying
Diagnosing Death
Confirm irreversible cessation of neurological (pupillary), cardiac and resp activity.
Drs (and some trained nurses) role
No pulses, absent breath and heart sounds
pupils fixed and dilated, no corneal reflex
no motor response to supraorbital pressure
who can sign a death certificate
seen the person within the last 14 days before they died (covid now 28 days), not necessary to have seen the body after death as long as death certified by a competent person.
When to refer to the coroner
unknown cause of death
sudden or unexpected death (<24hrs after admission to hospital)
Deceased person has not seen a dr within the 14 days before death
suspicious, unnatural or violent
accident,
infant death, self-neglect or neglect
prior employment
adue to an abortion
occured during opperation or before recovery from anaesthetic
during or shortly after police custody
suicide
writing a death certificate
Part 1 - cause of death.
1a - the disease(/s) or condition that led directly to death
1b - any disease(/s) that lead to 1a
1c - any disease(/s) that lead to 1b
Part II - any other conditions that were not part in the main cause of death, but may have had an impact in hastening it (NOT entire PMH)
Box A -write in initial if have reffered to coroner
Box B - initial if may have more information in the future (e.g. lab results arent back yet)
who can sign cremation certificate
3 parts - dr caring for patient, independant dr, crem officer.
1st Dr must talk to 2nd dr, 2nd dr would talk to 3rd party (staff member or next of kin) to confirm details.
Both Drs must have seen the body after death
when do you need consent to do an autopsy
need consent from next of kin if being done for research or to better understand cause of death. if death has to be reffered to the coroner, then consent does not need to be given. However consent is needed if tissues are to be removed or retained.
CD4 count for AIDS
200
AIDS defining illness
resp - recurrent bacterial pneumonia, TB, PCP (pneumocystis jirovecii, fungus)
CNS - toxoplasmosis, cryptococcal meningitis, primary cerebral lymphoma (associated with EBV)
skin - karposi sarcoma (Human herpes virus 8). in mouth = bad prognostic indicator)
GI - bacterial, CMV (can also effect eyes), cryptosporidium, microsporidia, mycobacterium avium intracellulare (rare form of TB)
Lymph - NHL, diffuse large B cell, Burkitts
what does toxoplasmosis look like on CT
adscess, effect basal ganglia, associated with severe oedema, ring enhancing
blood test to monitor HIV
CD4 count (normal >500) Viral load (undetectable (<20/40 copies per ml)
mechanism of NRTI (nucleoside reverse transcriptase inhibitors)
stop viral RNA being converted to DNA by competing for binding sites
mechanism of NNRTI (non nucleoside reverse transcriptase inhibitors)
stop viral RNA being converted to DNA by blocking binding sites
protease inhibitor mechanism
stop new copies of HIV being produced by preventing productions of units needed for capsule formation
integrase inhibitors mechanism
stop viral DNA integrating into host cell DNA
NRTI example
tenofovir, stavudine, emitricitbine, lamivudine, zidovudine
NRTI side effects
N&V, fatigue, headache, myelosuppressinon (Aneamia, bone marrow), panreatitis, neuropta
Analgesic Ladder
Step 1: non-opioid +/- adjuvant.
1. paracetamol
2. ibuprofen
3. Paracetamol and ibuprofen
4. paracetamol + alternative NSAID
Step 2: weak opioid (tramadol, codeine, co-proxamol, co-codamol, dihydrocodeine)
Step 3: strong opioid (morphine) +non-opioid +/- adjuvant
Mechanism of paracetamol
inhibit Cox in CNS
what type of pain are NSAIDs good for
inflammatory, bone pain, NOT neuropathic pain
side effects of NSAIDs
gastric irritation (dyspepsia, ulceration)
Brocnhospasm in asthmatics
May precipitate renal failure
