Palliative Care Emergencies Flashcards
define palliative care
“Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
why is the nurses inout key in palliative care emergencies
- Nurses input in vital
- Have established knowledge of patient
- Nurse’s assessment is very valuable and it’s important that you voice your concerns to the relevant people
- Clear thinking and a calm approach can greatly help situation
- Prompt decision making is key
what should be considered for if treatment is appropriate
¥ What are the patient’s wishes?
▫ Preferred place of care and preferred place of death
▫ Thoughts on management of acute situations
▫ Wishes regarding transfer to hospital/hospice
¥ Family/carer wishes
¥ What is the stage of disease and estimated prognosis?
¥ What does the patient look like at time of assessment?
¥ What impact will treatment have on the patient?
describe prevalence of malignant spinal cord compression (MSCC)
¥ Occurs in 5 – 10 % of people with cancer
¥ Highest frequency in patients with lung, breast, prostate cancers and myeloma
¥ However, should be considered as a possibility in all patients with malignancy
¥ High index of suspicion if already known to have bone involvement
¥ 1 in 5 cases are first presentation of malignancy
What is MSCC?
¥ Cancer within the spine compresses spinal cord or cauda equina
¥ Can be caused by direct pressure, vertebral collapse or instability, or direct tumour extension into spinal canal
¥ Sites of compression
▫ Thoracic – 70%
▫ Lumbosacral – 20%
▫ Cervical – 10%
what are signs and symptoms of MSCC
¥ Back pain
▫ Need to tease out history, especially if already a history of back pain
▫ Often first symptom, present in 90% of cases
▫ May describe new spinal root pain – ‘sharp, burning, shooting or like a band’
▫ Coughing, straining, lying flat can make pain worse
¥ Leg weakness, difficulty walking, unsteady on feet
¥ Numbness/tingling in limbs
¥ Bladder or bowel disturbance
¥ Saddle area numbness
describe management of MSCC
¥ Must be treated as an emergency, if appropriate
¥ High dose dexamethasone, 16mg daily, should be started immediately
¥ Urgent MRI
¥ Patient may need to be managed as a spinal injury patient
¥ Radiotherapy
¥ Surgery
¥ Gastroprotection, omeprazole
¥ LMWH
¥ MDT approach
what is the prognosis of MSCC
¥ 30% of patients may survive for one year
¥ If ambulant after treatment, survival could be up to ~9 months
¥ If paraplegic after treatment, survival is only a few weeks
¥ Function will return to 70% patients who were ambulant pre treatment
¥ Function will return in 5% of patients who are paraplegic at time of diagnosis
¥ Prompt diagnosis is key
What is the SVC?
A large vein that receives blood from the head, neck, upper extremities and thorax and delivers it to the right atrium of the heart
what can SVC Obstruction can be caused by
¥ Compression of SVC by tumour mass or lymph nodes
¥ Clot within the SVC
¥ Direct invasion of cancer into the vessel
¥ 75% caused by lung cancer
¥ 15% caused by lymphoma
¥ 10% caused by other cancers
what are signs and symptoms of SVC obstruction
¥ Breathlessness, features of respiratory distress ¥ Headache ¥ Visual changes ¥ Dizziness ¥ Swelling of face/neck/arms/hands ¥ Engorged conjunctivae ¥ Periorbital oedema ¥ Dilated neck veins ¥ Dilated collateral veins on anterior chest and arms ¥ Cyanosis
how do you manage SVC obstruction
¥ Loosen any restrictive clothing ¥ CXR and CT scan may be required ¥ Steroids – dexamethasone 16mg daily ¥ Chemotherapy ¥ Radiotherapy ¥ SVC stenting ¥ Symptom management for breathlessness, hypoxia, headache and anxiety
what is hypocalcaemia
¥ Increased blood calcium level
¥ Adjusted calcium > 2.65
¥ Life threatening metabolic disorder
¥ Occurs in 10 – 20% of people with cancer
¥ Most common cancers
▫ Multiple myeloma, breast, lung, prostate, renal
¥ Different causes
▫ Released from bone metastases
▫ Production of a parathyroid related hormone
▫ Vitamin D related
¥ 80% of people die within 12 months
what are symptoms of hypocalcaemia
¥ Lethargy ¥ Nausea ¥ Vomiting ¥ Drowsiness ¥ Confusion ¥ Thirst ¥ Polyuria ¥ Constipation ¥ Abdominal pain ¥ Bone pain ¥ Seizures
describe management of hypocalcaemia
¥ Dependant on patient situation ¥ IV fluids ¥ Bisphosphonates ▫ Disodium pamidronate ▫ Zolendronic Acid ▫ Inhibit tissue breakdown in bones ▫ Calcium starts to fall after 48 hours and continues to fall for ~7 days
