Palliative Care ILOs Flashcards
Give 3 key questions to ask during a confusion history
- Duration
- Recent trauma
- Recent medication changes
Give 3 general features to assess in the examination of a confused pt.
Sign of trauma
Hydration Status
Frailty Score
Give 6 systems which should be considered during the examination of a confused pt.
CVS Respiratory GI Neuro Psychiatric MSK
Define dementia
Decline in cognition involving one or more cognitive domains
Describe the pathology of Alzheimer’s dementia
- Accumulation of beta-amyloid peptide
- Neurofibrillary tangles/amyloid plaque and loss of acetylcholine
Give 2 management options for Alzheimer’s
Acetylcholinesterase inhibitor e.g. Donepezil
Correct vascular risk factors
State the two types of vascular dementia
Post-stroke dementia
Vascular dementia without recent stroke
Give 3 additional symptoms in Lewy Body dementia alongside the general symptoms of dementia
Visual hallucination
Parkinsonism
Sleep disorder
Give 3 symptoms of fronto-temporal dementia
- Change in personality
- Disinhibition
- Compulsive behaviour
Give 4 causes of delirium
Infection
Polypharmacy
Electrolyte imbalance
New environment
Give 3 non-pharmacological management options for delirium
Treat underlying cause
Talk to pt. calmly
Ensure pt. has hearing aid/glasses
Give 2 pharmacological management options for delirium
Antipsychotics e.g.
Haloperidol
Benzodiazepines e.g. Lorazepam
What are the 4 domains of palliative care?
- Physical
- Psychological
- Social
- Spiritual
Where is the vomiting centre located?
Medulla Oblongata
Name 3 areas of input to the vomiting centre
Chemoreceptor trigger zone
Vestibular
CNS
Name the location of the chemoreceptor trigger zone and give 2 triggers
Outside BBB in 4th ventricle
Opioids
Chemotherapy
Give 3 non pharmacological methods used in palliative care
Mouth care
Avoid constipation
Regular small meals
What is metoclopramide and what is it used for?
Dopamine antagonist anti-emetic which stimulated bowel and chemoreceptor trigger zone
Used in impaired gastric emptying
What is cyclizine and what is it used for?
Histamine receptor antagonist targeting vomiting centre
1st line in raised ICP, motion sickness and complete bowel obstruction
What is Ondansetron and what is it used for?
Serotonin receptor antagonist anti-emetic
1st line chemo nausea, post-op
What is Haloperidol and what is it used for?
Dopamine antagonist working on chemoreceptor trigger zone
Used in delirium
What is Levomepromazine and what is it used for?
Systemic anti-emetic which works everywhere
1st line in indeterminate cause or when other 1st lines don’t work
Give 3 indicators of the dying phase
Poor appetite
Profound weakness
Difficulty swallowing
Give 2 barriers to diagnosing dying
Futile interventions
Disagreement on resuscitation
What is the ECOG score?
Determines if a patient is fit enough for chemo/radiotherapy
0-2 = fit 3 = limited self-care 4 = completely disabled 5 = dead
What does the SPICT tool help identify?
Who would benefit from palliative care services
