Tutorial 2

Question 1

definition of sympathy

Answer 1

A pity-based response to a distressing situation that is characterized by a lack of relational understanding and the
self-preservation of the observer. There is no conscious thought and reflection.

Question 2

definition of empathy

Answer 2

An affective response that acknowledges and attempts to understand an individual’s suffering through emotional resonance
Empathy enters into another’s suffering … it’s just the ability
to be there

Question 3

definition of compassion

Answer 3

A virtuous response that seeks to address the suffering and needs of a person through relational understanding and action

Question 4

acute pain

Answer 4

*definable acute injury or illness
*transient and forseeable
*accompanied by clinical signs of sympathetic over activity
*treatment is directed to the acute illness or injury
* positive pain- it is protective
* PRN medication

Question 5

chronic pain

Answer 5

*chronic pathological process
*continues for years and may become worse
* no sympathetic over activity
*psychological changes
*treatment of underlying conditions where possible but regular analgesia required
*the pain serves no meaning

Question 6

Physiological pain categories

Answer 6

Nociceptive
Neuropathic
Mixed pain

Question 7

Nociceptive pain examples

Answer 7

Visceral: e.g pancreatitis, PU, MI

Somatic e.g arthritis, bone metastases, cellulitis

Question 8

neuropathic pain example

Answer 8

herpes zoster
neuropathy

Question 9

mixed pain example

Answer 9

cancer pain

Question 10

classification of chronic pain

Answer 10

nociceptive pain
neuropathic pain (predominant)
sensory hypersensitivity

Question 11

nociceptive pain

Answer 11

pain related to damage of somatic or visceral tissue due to trauma or inflammation

Question 12

neuropathic pain

Answer 12

pain related to damage of peripheral or central nerves

Question 13

sensory hypersensitivity

Answer 13

pain without identifiable nerve or tissue damage thought to result from persistent neuronal dysregulation-

Question 14

nociceptive pain

Answer 14

produce by nonciceptors (pain receptors) in the tissue

nerve pathways are normal and intact

well localized

responds well to opioids

Question 15

visceral pain

Answer 15

activation of nociceptors

infiltration, compression, distension of thoracic and abdominal viscera

poorly localised

often referred

Question 16

neuropathic pain

Answer 16

damage to the central or peripheral nervous system

central vs “deafferentation”

injured nerves react abnormally to stimuli or discharge spontaneously

burning, tingling, shock like, needles and pins

less sensitive to opioids and may require adjuvant

Question 17

physical causes of pain

Answer 17

primary disease (e.g. tumor inflitration)

treatment (e.g. surgery, radiation)

general debility (e.g. pressure sores, constipation)

concurrent disorders (e.g. arthritis)

Question 18

pain assessment

Answer 18

*twycross “pain is what the patient says hurts”
*history: precipitating/ relieving factors (including medications tried)
*quality of pain- description
*radiation of pain
*site of pain
*severity of pin
*time course

Question 19

cultural aspects of pain assessment

Answer 19

barriers of communication
description of pain
access to drugs
under reporting of pain
gender inequalities

Question 20

management of pain

Answer 20

diagnosis of cause of pain
explain to patient
emotional/ psychological support
treatment options
individualize treatment
assess and reassess

Question 21

WHO analgesic ladder

Answer 21

step 1: non- opioid +/- adjuvant

step 2: weak opioid +/- step 1

step 3: strong opioid +/- step 1

Question 22

principles of analgesic use

Answer 22

by the mouth
by the clock
by the ladder

Question 23

principles

Answer 23

-Weak opioids should not be combined with strong opioids.
-Non-opioids may be combined with strong or weak opioids
-Adjuvant analgesia can be added to any step of the WHO step ladder

Question 24

analgesic step 1

Answer 24

paracetamol
-aspirin/ NSAIDS

Question 25

analgesic step 2

Answer 25

codeine/ tramadol
- paracetamol- codeine
-paracetamol- tramadol

Question 26

analgesic step 3

Answer 26

morphine
-mist morphine
-morphine tabs
-morphine sulphate inj

fentanyl patches

Question 27

strong opioids

Answer 27

no important differences between morphine, oxycodone, hydromorphone, orally

Question 28

side effects of morphine

Answer 28

temporary confusion, drowsiness
nausea and/or vomiting
constipation

Question 29

toxicity

Answer 29

*Opioid toxicity should not occur with careful titration of morphine dose
*The most frequently encountered symptom of toxicity is myoclonus usually at end of life when renal failure precipitates accumulation of M-6-G (metabolite) which causes myoclonus. Reduction of morphine dose is required.
*Severe somnolence/drowsiness
*Hypotension
*Respiratory depression

Question 30

problems prescribing opioids

Answer 30

-Opioid phobia
-Lack of counselling
-Drugs to manage side effects
-Incorrect labelling
-Drug abuse in our society

Question 31

contra-indications

Answer 31

1. allergy
2. renal failure
3. liver failure

Question 32

fatigue

Answer 32

Subjective feeling of tiredness, weakness or lack of energy.

In 80% of cancer patients and in 99% of patient post chemo or radiotherapy

Primary fatigue
The disease itself (cytokine release from the tumour)

Secondary fatigue
anaemia, cachexia, fever, infections or metabolic, disorders as well as sedative drugs for symptom control.

Question 33

The jug technique

Answer 33

A communication skills technique also effective when addressing emotionally charged conversations

Question 34

Approach to psychosocial management: CEASER

Answer 34

C- communication skills and attitudes
E- ethical principles
A- advocacy
S- Support
E- empower
R- reassure

Question 35

Communication skills and attitudes

Answer 35

REC : Respect, Empathy, Compassion

Question 36

Ethical principles

Answer 36

Autonomy
Beneficence
Non- maleficence
Justice

Question 37

Advocacy

Answer 37

to be guided by ethical principles (what is to benefit patient and/or Justice)

Question 38

Support

Answer 38

– offer ongoing support to the family through Information and Networking – refer to HBC/Hospice/NGO’s/CANSA/counselling/Social worker/DG grants etc.

Question 39

Empower

Answer 39

How can the patient and/or family caregivers/support system be empowered – education/family meeting/physio/OT/dietician/speech

Question 40

Reassure

Answer 40

to alleviate patient’s concern and worry; (inform patient about something positive to dispel anxiety or fear)
– review/follow up/refer

Question 41

Family meeting

Answer 41

Who, what, where – ask patient and family

Introductions

How much do the family know?

Information in language they understand, small chunks, written instructions
– ask – tell – ask – tell / make use of silence

Who will be the caregiver?

What else do they need?

S/W/Physio/OT/dietician/HBC etc

Exchange contact details for f/u/review

Question 42

Approach to spiritual care

Answer 42

Meaning
Legacy
Guilt and blame
Hope
Death and dying

Question 43

FICA

Answer 43

F - Faith/Belief/Religion?

I - Importance?

C - Community supportive?

A - Assist?

Question 44

Problem List- Physical

Answer 44

-? Main Diagnosis
-Ongoing pain control
-Anorexia
-Dysphagia -? Side effects/? Reflux
-Pressure care/bedsores
-Addressing concerns of dehydration/nutrition at end of life

Question 45

Problem list- Psychosocial

Answer 45

Identify preferred place of care
Address family concerns and needs

Question 46

Problem list- Spiritual

Answer 46

Meaning – what is it that patient attaches to the illness?
Hope – currently, what is the patient hoping for?
Death and Dying – What are the patient’s concerns/views regarding their passing?