Palliative Care Handbook

Question 1

What are some psychological interventions for delirium?

Answer 1

clock
personal belongings
family members
clarification, validation, repetition
touch
empathy

Question 2

How to administer haloperidol in acute delirium?

Answer 2

Drug of choice for severe delirium.

Only if severe and combine w/ non-pharmalogical

Oral (less side effects than IV so always do oral if can swallow and compliant), 0.5 to 1.5 mg. Repeat every 30-40 mins until controlled.

In general don’t exceed 3mg .. unless young and very aggressive.

Question 3

What is terminal agitation?

Answer 3

Prolonged delirium, this may indicate physical,
psychological and/or spiritual discomfort. It is usually a ‘pre-death’ event.

Physical: urinary retention, distended rectum, physical restraint, insomnia, uncomfortable

psych/spiritual: anger, fear, hopelessness etc

Question 4

What constitutes palliative sedation?

Answer 4

Benzos, antipsychotics, opioids

Question 5

When is it best to give dexamethasone?

Answer 5

Before noon as can cause insomnia

Question 6

Drugs to give in raised ICP + vomiting

Answer 6

Cyclizine for vomiting, dexamethasone for brain oedema

Question 7

2 nausea situations where we give cyclizine

Answer 7

1) complete obstruction
2) raised ICP/radiotherapy to head

Question 8

Haloperidol can be used in which type of nausea?

Answer 8

morphine nausea, hypercalcaemia

Question 9

General principles of push forward vs pull back

Answer 9

Push forwards: metoclopramide, laxatives, PR intervention

Pull back: cyclizine, buscopan, NG tube

Both - steroids

Question 10

Should we give benzos for SOB?

Answer 10

Not unless anxiety + SOB

Question 11

What are the shared goals of care categories?

Answer 11

A - attempt CPR, ICU, MET calls
B - no CPR, ICU?, MET
C- no CPR, no ICU, MET?
D - nothing