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Sheff 3b > Palliative medicine > Flashcards

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
Q

If a pt is going to die in next few days

Name 3 priorities in care

A

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
Q

Good communication dramatically improves the bereavement process.

How is formal support offered?

A

as counselling, referral to GP, specialist psychological therapy

27
Q

Palliative care emergencies mx ?

Malignant spinal cord compression

SVCO

Malignant hyperclcaemia

A

8mg IV dexamethasone BD + analgesia

dexamethasone 8mg BD

IV zoledronic acid and IV fluids

28
Q

Name 2 DDX of confusion in dying

A

Hypercalcaemia, infection, brain metastasis

29
Q

If someone lacks capcity and need to prevent them from leaving what do you use? acid test for this?

A

DOLS (MCA)

1) person under continuous supervision 
AND
 2) is not free to leave 
AND
3) cannot consent to these arrangements
30
Q

How can patient claim benefits in palliative care

A

DS1500 form

-filled by doctor / specialist nurse

Sheff 3b (33 decks)

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