Teaching on the Wards

Question 1

What is the benefit of steroids in palliative care prescribing? What are the risks?

Answer 1

Can help with general well-being and mood
Help patients to increase their appetite and gain weight

If no clinical improvement in one week unlikely to happen at all
Risks include proximal myopathy which can decrease mobilisation and worsen outcomes

Question 2

Metoclopramide is a useful prokinetic used in palliative care. Who should not be prescribed it?

Answer 2

don’t give in people with colicky pain as this suggests the bowel is contracting hard against obstruction already and increases risk of rupture

Question 3

Give some key side effects of immunotherapy

Answer 3

GI upset - diarrhoea
Flu like symptoms - malaise, achey
Rash - widespread dermatitis
Organ inflammation - hepatitis, colitis, pneumonitis

Question 4

How can you manage side effects caused by immunotherapy?

Answer 4

Stop tx, consider steroids, supportive care

Question 5

How may sickle cell patients present to hopsital?

Answer 5

Painful crises - due to occlusion of vasculature by sickle cells

Acute chest syndrome - due to necrotic bone marrow embolising and travelling to the chest

Stroke - ischaemic in younger and older patients, haemorrhagic in middle age group

Priaprism

Question 6

How can you manage an acutely unwell sickle cell patient?

Answer 6

Keep them warm

Oxygen - these patients are often very oxygen sensitive, aim to have them on air when doing ABG ( unless sats very low)

IV fluids to reduce viscosity of blood

Question 7

What analgesics should you offer a patient with a painful sickle crisis?

Answer 7

Oramorph, SC morphine, PCA
Refer to pain care plan in notes
Avoid pethadine due to seizure risk and avoid IV opioids due to poor vascular access in these patients

Question 8

What can be used in the long term mx of sickle cell patients?

Answer 8

Prophylactic abx - eg penicillin due to risk from encapsulated organisms (splenic sequestration may cause splenomegaly and then splenic rupture whilst still young -palpate spleen when assessing all sickle cell patients)

Hydroxycarbamide

Folic acid - lost in haemolysis

Question 9

What can you do to help palliate a patient who is breathless?

Answer 9

suggest pursed lip breathing / tripod positioning
rectangle breathing
handheld fans
low dose morphine
benzos if very anxious