Palliative medicine Flashcards

1
Q

3 parts to palliative care

A

Physical
Psychosocial
Spiritual

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2
Q

3 reasons for Sx relief in palliative

A

Reduces QoL

Causes distress

Results in admissions

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3
Q

Name 3 causes of nausea and vomiting

A

Bowels - Mucositis, constipation, infection, obstruction

Brain 0 raised ICP

Biochemical - Medications, hypercalcaemia, uraemia, infection, hypomagnaesaemia

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4
Q

How do these places play a role in Nausea

Gut wall?
Chemoreceptor trigger zone?
limbic?
vestibular?

A

Gut wall: distension stimulates vagus - constipation, obstruction, chemo stimulates enterochromaffin cells

Chemo - uraemia, drugs, chemotherapy, hypercalcaemia

Limbic - emotion

Vestibular - motion sickess / vertigo

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5
Q

Name some antiemetics ///

A

Bowel only cause
Domperidone Hyoscine butylbromide

Bowel+brain
Haloperidol / metoclopramide

Brain
cyclizine / levopromazine

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6
Q

Why shouldn’t you prescribe cyclizine and metoclopramide

A

c - constipating

M - diarrhoea

Counteract each other in bowel

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7
Q

What is pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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8
Q

Goals of Nx in pain

A

A good night’s sleep

Pain free at rest

Pain free on movement

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9
Q

When is the WHO pain ladder used

A

Cancer pain

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10
Q

3 Stages of pain ladder and Eg of 2 drugs in each

A

Simple
-Para / NSAIDs

Weak opiods
Codeine / tramadol

Strong
-Morphine, oxycodone, buprenophine, fentany, methadone, ketamine

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11
Q

When you move from weak opiods to strong do you continue the weak?

A

All have a CEILING EFFECT therefore REPLACE with strong opioid rather than add

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12
Q

Which do we prefer morphine or oxycodone?

A

Oxycodone - stronger + less SEs

Can get tablets and immediate release

-Deal with background and breakthrough pain

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13
Q

Common SEs with morphine?

A

Constipation, sedation, nausea, dry mouth

[-> Stimulant laxatives + PRN antiemetics]

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14
Q

Intresting Resp fact with opiates?

A

tend to reduce RR BUT increase tidal volume!

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15
Q

Which can you give if RR<8 AND SpO2 <92% due to opioids?

A

Naloxone

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16
Q

When would you use fentanyl ? How long does it take to work?

A

For STABLE opioid responsive pain

Indicated for poor oral route, or renal impairment

12 hours to reach analgesic concentration so not for acute pain (lasts 72 hours)

17
Q

Good drug for pain+

Neuropathic pain?
muscle spasms?
compression sx?
bone pain?

A

Neuro
amitryptilline
pregabalin, gabapentin

Spasms
Baclofen / benzos

Compression
steroids

Bone
bisphos Eg zolendronic acid

18
Q

Name 3 key things in terminal care - Is anything legally binding?

A

Advance care planning

  • Advance statements
  • Advanced refusal of treatment - THIS ONE IS LEGALLY BINDING

Power of attorney

DNACPR

19
Q

3 things How to recognise dying

A

***CV changes (pulse, mottled skin, cool peripheries)

***Resp changes (noisy secretions, laboured breathing)

Weight loss and poor appetite

Fatigue

Poor mobility

Social withdrawal

Struggling with medications

20
Q

What format do you communicate with dying patient and what do you need to do?

A

SBAR SBAR SBAR SBAR

document after

21
Q

Name 2 things in advanced care planning

A

Preferred place

Medical interventions they would or wouldn’t want e.g. ADRT IV ABX, PEG, escalation

DNACPR

A bucket list for the patient

22
Q

name 3 key Sx in dying

A
Pain
Breathlessness
Respiratory secretions
Nausea and vomiting
Distress/agitation
23
Q

Mx of these Sx in dying

Pain
Breathless 
secretions 
n+v
agitation
A

Pain PRN morphine

Breathless
PRN opioid SC and SC benzodiazepines

Secretions
Hyoscine / buscopan

N+V - Haloperidol

Agitation - midazolam

24
Q

Maxrogols and lactulose often poorly tolerated in mx of constipation so what is usually used in dying

A

A stool softener and stimulant laxative

Docusate and senna

25
If a pt is going to die in next few days | Name 3 priorities in care
Possibility is recognised and clearly communicated to patient Sensitive communication occurs between staff and patient/family Dying person/family involved in treatment and care planning Needs of family are identified and actively explored An individual plan of care including food and drink, symptoms and psychosocial/spiritual support is delivered
26
Good communication dramatically improves the bereavement process. How is formal support offered?
as counselling, referral to GP, specialist psychological therapy
27
Palliative care emergencies mx ? Malignant spinal cord compression SVCO Malignant hyperclcaemia
8mg IV dexamethasone BD + analgesia dexamethasone 8mg BD IV zoledronic acid and IV fluids
28
Name 2 DDX of confusion in dying
Hypercalcaemia, infection, brain metastasis
29
If someone lacks capcity and need to prevent them from leaving what do you use? acid test for this?
DOLS (MCA) ``` 1) person under continuous supervision AND 2) is not free to leave AND 3) cannot consent to these arrangements ```
30
How can patient claim benefits in palliative care
DS1500 form | -filled by doctor / specialist nurse