Palliative care base week Flashcards
How is airflow obstruction staged?
Using GOLD
- Globing initiative of chronic obstructive lung disease
GOLD 1: mild
GOLD 2: Moderate
GOLD 3: severe
GOLD 4: very severe
What are some advanced interventions for COPD?
- Oxygen therapy
- Ventilatory support
- Lung volume reduction surgery
- Bullectomy
- Lung transplant
- Endobronchial valves
What is the BODE index?
It predicts survival in COPD patients
4-year survival:
0-2: 80%
3-4: 67%
5-6: 57%
7-10: 16%
How are COPD symptoms controlled in palliative care?
Dyspnoea
Opiates, Fan therapy, Pulmonary rehabilitation
Nutritional support as BMI < 18 kg.m-2 carries increased mortality
Panic, anxiety and depression
Antidepressants, Benzodiazepines, CBT
What are some causes of breathlessness?
- Related to underlying condition (lung metastases/PE’s)
- Consequences of treatment (anaemia)
- Concurrent illness (infection)
- Associated factors (anxiety/ panic)
What is dyspnoea?
Breathlessness
What is the mechanism for breathlessness in palliative care?
- An increase in respiratory drive/ effort to overcome a load
Eg. COPD and asthma. - An increase in respiratory muscle force needed
Eg. neuromuscular weakness in which the sense of effort increases - An increase in ventilatory requirements
E.g anaemia or hypoxaemia
Higher cortical experience contributing to sensation
Eg. Memory and previous experience as well as fear and anxiety will all modify the sensation of breathlessness
What is the SPICT tool?
Supportive and Palliative care indicators tool (SPICT)
It helps identify people with deteriorating health due to advanced conditions or a serious illness, and prompts holistic assessment and future care planning
How is heart failure classified?
Based on left ventricular ejection fraction (LVEF)
What is the New York Heart Association (NYHA) classification of heart failure?
It’s functional, so based on symptoms
Class I: no limitation of physical activity
Class II: slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in undue breathlessness, fatigue, or palpitations
Class III: marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in undue breathlessness, fatigue, or palpitations
Class IV: unable to carry out any physical activity without discomfort. Symptoms at rest can be present
What is the prognosis for heart failure with a NYHA class 4?
Only 65% of patients are alive after 17 months
About 50% die 5 years after diagnosis of heart failure
What are some poor prognostic indicators for heart failure?
- Increased age
- Reduced ejection fraction
- Comorbidities (AF, CKD, COPD, DM, depression)
- Worsening severity of symptoms
- Clinical signs - raised JVP, 3rd HS, low SBP, tachycardia
- Obesity or cachexia
- Smoking
- Heart failure 2o to IHD (esp. MI)
- Complex ventricular arrhythmias (frequent VEs, NSVT)
What is end-stage heart failure?
- Patients who are at risk of death within 6-12 months
- Persistent symptoms despite maximal therapy
What are some clinical indicators of end-stage heart failure?
- Frequent hospital admissions
- Poor response to treatment and NYHA Class IV
- Cardiac cachexia
- Low Albumin
- Progressive deterioration in eGFR and hypotension limiting the use of drug treatments
- Acute deterioration and increasingly frequent hospital admissions from comorbid conditions (such as a chest infections)
- Poor quality of life and dependence on others for most activities of daily living
What are some advanced heart failure treatment options?
LV assist device (LVAD) or heart transplant
What is the definition of acute liver failure?
Jaundice to encephalopathy time < 4 weeks with no pre existing liver disease
What is the definition of chronic on acute liver failure?
Organ failure (including hepatic encephalopathy and coagulopathy) in presence of underlying chronic liver disease
What are some different types of motor neurone disease?
- Limb-onset (60-70%)
- Bulbar-onset (25-30%)
- Respiratory-onset (1-2%)
- Amyotrophic lateral sclerosis ALS (UMN+LMN)
- Progressive muscular atrophy PMA (LMN)
- Primary lateral sclerosis PLS (UMN)
What are bulbar muscles?
muscles in head and neck
What is Amyotrophic lateral sclerosis (ALS)?
A fatal MND
Neuropathological and genetic overlap
3 year survival after onset of symptoms
Diagnosed with gold coast criteria
What is King’s staging used for?
Amyotrophic lateral sclerosis (ALS)
What are some management options for drooling (sialorrhea)?
Hyoscine (Scopoderm) patch
Glycopyrrhonium (does not cross BBB)
Atropine 1% oral (eye) drops
Amitriptyline 10mg
Botox
What included in a ‘just in case kit’ for ALS?
Medication for acute laryngospasm / agitation / breathlessness
