WEEK 7 Flashcards
What is palliative care?
Improves the quality of life of pts & their families facing the problem(s) associted with life-threatening illness
- through the prevention & relief of suffering by means of early identification & impeccable assessment & treatment of pain & other problems (physical, psychosocial & spiritual)
What are the principles of delivering good end of life care? (HINT: there’s 6 points)
- Open lines of communication
- Anticipating care needs & encouraging discussion
- Effective multidisciplinary team input
- Symptom control - physical & psycho-spiritual
- Preparing for death - pt & family
- Providing support for relatives both before & after death
What are the areas for discussion during advance and anticipatory care planning? (HINT: there’s 7 areas)
- Wishes/preferences/fears about care
- Feelings/beliefs/values that may influence future choices
- Who should be involved in decision making?
- Emergency interventions e.g. CPR
- Preferred place of care
- Religious/spiritual/pther personal support
- May wish to make Advance & Anticipatory care plan/formalise wishes regarding care
What is the framework for assessing the validity of advance care decisions?
- Is it clearly applicable?
- When was it made?
- Did the patient have capacity when it was made?
- Was it an informed decision?
- Were there any undue influences when made?
- Has the decision been withdrawn?
- Are more recent actions / decisions inconsistent?
How important is good quality care in the last days or hours of life?
- Informative, timely & sensitive communication is an essential component of each individual person’s care
- Significant decisions about a person’s care, including `diagnosing dying, are made on the basis of multidisciplinary discussion
- Each individual person’s physical, psychological, social and spiritual needs are recognised and addressed as far as is possible
- Consideration is given to the wellbeing of relatives or carers attending the person
role of a medical history in making a clinical diagnosis
- Forms a differential diagnosis & put health in context
- Identify risk factors for conditions
- Red Flags
- Direct further clinical examination
- Direct investigation & management
- Develop a rapport between pt & healthcare worker
how to take a detailed drug history
For each drug, in turn
- name of medicine?
- do you know what it is for?
- what is the dose/strength?
- what is the route
- number of tablets or puffs or dose units taken?
- type/form - device type?
- how often do you take this?
- any recent changes to dose/frequency?
What is a useful mneumonic for asking all the clarifying chest pain questions?
SOCRATES
- site
- onset
- character
- radiation
- associated symptoms
- timing
- exacerbators/relievers
- severity (1-10 rating scale)
What are specific respiratory questions asked?
- Chest Pain
- SOCRATES - Dyspnoea
- Cough
- how long had it, when occur
- anything make better or worse
- dry cough? cough anything up? - Sputum
- how often produced? How much? colour? blood? frothy or thick? smell? - Haemoptysis
- how much blood? any other colours? any breeding or bruising? taking blood thinners? - Wheeze
- Systemic upset
What are the respiratory causes of dyspnoea?
Airways - asthma, COPD, bronchiectasis, cystic fibrosis, larygeal tumour, foreign body, lung tumour Parenchyma - pneumonia, pulmonary fibrosis, sarcoidosis, TB Pulmonary Circulation - PE Pleural - pneumothorax, pleural effusion Chest Wall - kyphoscoliosis, ankylosing spondylitis Neuromuscular - myasthenia gravis, Guillain-Barre syndrome
What does an (i) acute cough (ii) chronic cough suggest?
(i) viral or bacterial infection pneumonia inhalation of foreign body irritants (ii) common = gastro-oesophageal reflux, asthma, COPD, smoking, post-nasal drip, occupational/other irritants, medication (ACEI)
What causes an (i) acute cough (ii) chronic cough?
(i) viral or bacterial infection
pneumonia
inhalation of foreign body
irritants
(ii) common = gastro-oesophageal reflux, asthma, COPD, smoking, post-nasal drip, occupational/other irritants, medication (ACEI)
less common = lung tumour, bronchiectasis, interstitial lung disease
What are the causes of central chest pain? (HINT: there’s 7)
tracheitis angina/MI aortic dissection massive PE oesphagitis lung tumour/metastases mediastinal tumour/mediastinitis
What are the causes of non-central (i) pleural (ii) chest wall pain?
(i) pneumonia/bronchiectasis/TB lung tumour/metastases/mesothelioma PE pneumothorax (ii) muscular/rib injury costochondritis lung tumour/bony metastases/mesothelioma shingles
What are the conditions associated with dyspnoea that onsets in minutes? (HINT: there’s 5 conditions)
PE Pneumothorax Acute LVF Acute asthma Inhaled foreign body
What are the conditions associated with dyspnoea that onsets in hours to days? (HINT: there’s 3 conditions)
Pneumonia
Asthma
Exacerbation of COPD
What are the conditions associated with dyspnoea that onsets in weeks to months? (HINT: 3 conditions)
Anaemia
Pleural effusion
Respiratory neuromuscular disorders
What are the conditions associated with dyspnoea that onsets in months to years? (HINT: 3 conditions)
COPD
Pulmonary fibrosis
Pulmonary TB
What is the appearance & cause of serous sputum?
Clear, watery, frothy, pink
- acute pulmonary oedema
What is the appearance & cause of mucoid sputum?
Clear, grey, white, viscid
- COPD/asthma
What is the appearance & cause of purulent sputum?
Yellow, green, brown
- infection
What is the appearance & cause of rusty sputum?
Rusty red
- pneumococcal pneumonia
What is 2 examples of malignant haemoptysis?
bronchial carcinoma
metastatic lung disease
Name 3 examples of infective haemoptysis?
acute infection
bronchiectasis
TB