Palliative care management Flashcards
What is the difference between nausea and vomiting?
Nausea = sensation of desire to vomit
Vomiting = expelling GI contents via mouth
What can cause N&V in palliative care patients?
Cancer = brain mets or bowel obstruction
Complications = hypercalcaemia
Debility = infection / constipation
Treatment = chemo
Where do antiemetic drugs work?
Chemoreceptor trigger zone
Vomiting centre (in the brainstem)
Which anetiemetics are indicated in chemotherapy?
Nausea is strongly mediated by 5HT
Moderate = dexamethasone and metoclopramide
Severe = 5HT3 receptor antagonist (ondansetron) and dex
What are some non-pharmacological treatments of N&V in palliative care?
Hypnotherapy
Small meals / snacks
Cover odorous wounds
Sea bands / acupressure
What are some causes of pain in palliative care?
Result of treatment e.g. neuropathy from chemotherapy
Unrelated DVT / pressure sores
How is analgesia prescribed in palliative care?
IR morphine initially for 24 hrs PRN (oramorph) ot SC morphine
Conversion to slow release morphine e.g. zomorph via a syringe driver
What to prescribe alongside morphine?
Antiemetic (cyclizine - antihistamine)
Laxative
What may cause SoB in palliative care?
Effects of cancer e.g. lung cancer
Pulmonary effusion
Restriction e.g. SVC obstruction
Pulmonary embolus
Anaemia
Pneumonia
Pain
Anxiety
What is the management of SoB in palliative care?
Treat underlying cause e.g. drain an effusion
Lifestyle changes
Symptomatic e.g. pharmacological
Rehab
What pharmacological treatments are there for SoB in palliative care?
Nebulisers e.g. bronchodilators (salbutamol)
Opiods e.g. oramorph 2.5mg PRN 4hourly
Benzos e.g. lorazepam
For secretions = glycopyrronium or hyosceine hydrobromide
What are some non-pharma treatments for SoB in palliative care?
Oxygen
Physio and positioning (sitting down & leaning forwards)
Fans
Psychotherapy for anxiety
