Palliative pain and Symptom management: Flashcards

1
Q

Palliative pain and symptoms control:

Outline medications commonly used in palliative care:

What is the major goals of end of life care?

A

To kep patients comfortable and make unecessary sufferring not happen.

QUALITY of life

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2
Q

What are common end of life symptoms?

A

1) Pain
2) nausea
3) SOB

End of life agitation: + Secretions:

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3
Q

What is a PQRST pain assessment?

A
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4
Q

What are non verbal assessments of pain?

A
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5
Q

How do we choose pain relief in palliative patients? (how do we assess)

A

Previous opiods?

Time frame?

Is actually working?

Are they using them correctly?

Absorption of the medications?

Route?

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6
Q

What are other reasons why palliative patients can have pain?

A

75% of people

Urinary retention: NEED to consider this

Hypercalcemia: NEed to consider this

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7
Q

Assessment of palliative care patient:

What are some non-pharm treatments? List

A

E.g xray vs ct shows:

Always consider non pharm management of pain!!!!!

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8
Q

What are the common palliative opioids?

A
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9
Q

Opiods: What and why?

Why use subcut?

A
  • Because in palliative care most patients will not have an IV (unsafe infection)
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10
Q

Transdermal opioids:

Buprenorphone and fentanyl

A
  • Very potent
  • Not recommended for first line (opiod)
  • Take 12 hours to work
  • Patches are less constipating
  • Inability to tirate doses
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11
Q

List opioid side effects: List by system:

List 8:

A
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12
Q

Which opioids is the best? in terms of side effects?

A
  • Opioids - Work better with Paracetomol

Cancer: if inflammation- NSAIDS help with pain management

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13
Q

Coanalgesics: What are they? When can they be used? Steroids- What role does they have? Bisphosphonates- what role do they have?

A

Lyrica: Pregablin

Duloxetine: SNRI

Amytrptiline:

Midazolam, Clonazepam- calms the mind and calms the pain

Dexamethasone: Whole body imunnosuppression

Bisphosphonate- Bony mets (hypercalcemia)

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14
Q

Coanalgesics side effects: Think polypharmacy

A
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15
Q

How do you calculate what dose?

What is your PRN or break through dose?

If wanting to give opioids for SOB?

A

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)

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16
Q

Morphine:

Oxycodone: (1.5x stronger than morphine)

IV vs oral?

Fentanyl- Sublingual, buccal lozenge,

Buprenorphine

Hydromorphone- 5x stronger than morphine

Use opioid calculator

A
17
Q

Assessment of pain management: outline an assessment:

incidentals vs breathrough?

A

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)

18
Q

ED case:

Pain crisis: How do you manage this properly?

How to manage

A
19
Q

Fears around opioids:

What issues should you address around patients fears?

A
20
Q

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!

A
21
Q

Breathlessness: in palliative:

A

Benzos are also effective- take away anxiety

Use oral morphine 1/10 LR dose

22
Q

Confusion: Delirum

A

oxycodone- metabolized by liver - thus become opioid toxic

23
Q

What are signs of opioid toxicity? List 8

A
24
Q

End of life: Plan for end of life event:

A
  • 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
25
Q

Medication review:

Cease all nonessential meds: Statins, antihypertensives

Countine certain medications: Cardiac and diuretics

A
26
Q

Analgesia when they cannot swallow:

USe regular PRN

What role dose syringe driver have?

A
27
Q

Anxiolytics

A
28
Q

Anitemetic:

A
29
Q

Antisecretory: Education is key around end of life - sounds

A
30
Q

End of life crisis:

Usually if catastrophic bleed is expected:

A

Can be nurse iniated

Have dark towels ready

education for family is key

31
Q

take home message:

A

USe adjuvants

Paracetomol

Benzos

dont use patches in acute pain

32
Q
A