Palliative pain and Symptom management: Flashcards
Palliative pain and symptoms control:
Outline medications commonly used in palliative care:
What is the major goals of end of life care?
To kep patients comfortable and make unecessary sufferring not happen.
QUALITY of life
What are common end of life symptoms?
1) Pain
2) nausea
3) SOB
End of life agitation: + Secretions:
What is a PQRST pain assessment?
What are non verbal assessments of pain?
How do we choose pain relief in palliative patients? (how do we assess)
Previous opiods?
Time frame?
Is actually working?
Are they using them correctly?
Absorption of the medications?
Route?
What are other reasons why palliative patients can have pain?
75% of people
Urinary retention: NEED to consider this
Hypercalcemia: NEed to consider this
Assessment of palliative care patient:
What are some non-pharm treatments? List
E.g xray vs ct shows:
Always consider non pharm management of pain!!!!!
What are the common palliative opioids?
Opiods: What and why?
Why use subcut?
- Because in palliative care most patients will not have an IV (unsafe infection)
Transdermal opioids:
Buprenorphone and fentanyl
- Very potent
- Not recommended for first line (opiod)
- Take 12 hours to work
- Patches are less constipating
- Inability to tirate doses
List opioid side effects: List by system:
List 8:
Which opioids is the best? in terms of side effects?
- Opioids - Work better with Paracetomol
Cancer: if inflammation- NSAIDS help with pain management
Coanalgesics: What are they? When can they be used? Steroids- What role does they have? Bisphosphonates- what role do they have?
Lyrica: Pregablin
Duloxetine: SNRI
Amytrptiline:
Midazolam, Clonazepam- calms the mind and calms the pain
Dexamethasone: Whole body imunnosuppression
Bisphosphonate- Bony mets (hypercalcemia)
Coanalgesics side effects: Think polypharmacy
How do you calculate what dose?
What is your PRN or break through dose?
If wanting to give opioids for SOB?
What was the pain before the medication?
How quickly did it work?
How long did the number go down?
How long dide it last for?
Any side effects?
Always chart maximum dose:
How many max doses? 6 (ask senior)
Morphine:
Oxycodone: (1.5x stronger than morphine)
IV vs oral?
Fentanyl- Sublingual, buccal lozenge,
Buprenorphine
Hydromorphone- 5x stronger than morphine
Use opioid calculator
Assessment of pain management: outline an assessment:
incidentals vs breathrough?
Adjust dose based on assessment of regular symptoms
adjust doses based on 24 hour usahe and change to LR
Give before doing something (e.g showering)
ED case:
Pain crisis: How do you manage this properly?
How to manage
Fears around opioids:
What issues should you address around patients fears?
68 yr male, SCLC- hOW TO MANAGE nAUSEA
Progression on first line
Presented with severe nausea and vomitting
What do we need to do?! FIND THE cause!
Breathlessness: in palliative:
Benzos are also effective- take away anxiety
Use oral morphine 1/10 LR dose
Confusion: Delirum
oxycodone- metabolized by liver - thus become opioid toxic
What are signs of opioid toxicity? List 8
End of life: Plan for end of life event:
- Recognize it:
- Plan for it:
- Need to stop things: Whats unecessary things (obs/bloods)
- Encourage communication (religous spiritual needs)
- Nursing focus to change
- After death care
Medication review:
Cease all nonessential meds: Statins, antihypertensives
Countine certain medications: Cardiac and diuretics
Analgesia when they cannot swallow:
USe regular PRN
What role dose syringe driver have?
Anxiolytics
Anitemetic:
Antisecretory: Education is key around end of life - sounds
End of life crisis:
Usually if catastrophic bleed is expected:
Can be nurse iniated
Have dark towels ready
education for family is key
take home message:
USe adjuvants
Paracetomol
Benzos
dont use patches in acute pain
