EoL Flashcards
Define palliative care
life-limiting illness, prevention/relief of suffering (physical, psychological, spiritual)
Define terminal care
Last day management, symptoms focused not prevention
What are the signs of EoL?
Death rattle breathing - due to resp secretions (breathing through phlegm) Cheyne-stokes - shallow/deep, start/stop breathing Mottled skin Cachexia Gaunt (cachexia) (temporalis wasting) Cold Decreased GCS Decreased urine output Decreased BP Agitation
What are the functional changes at the EoL?
Diff swallowing Decreased mobility Social withdrawal Decreased communication Decreased performance status
What are the symptoms of EoL?
Fatigue
Impending sense of death
Loss of appetite
Weight loss
What are the causes of N+V in advanced disease?
Hypoglycaemia Renal impairment HyperCa Infection Liver failure Medications - morphine, anticholinergics Anxiety RICP - cerebral mets/haemorrhage, meningeal disease Vestibular disturbance Constipation Malignant bowel obstruction
When is haloperidol used?
= metabolic/drug (chemical)
D2 blocker
SE = extra-pyramidal, restlessness, sedation
When is metoclopramide used?
= chemical, gastric stasis
D2 blocker
SE = extra-pyramidal (muscle spasms, tardive dyskinesia)
When is cyclizine used?
= bowel obstruction, raised ICP, motion sickness
Anti-cholinergic and H1 antagonist
Blocks conduction in vestibular-cerebellar pathway and acts at VC
SE = hypotension, urinary retention, dry mouth,
constipation, restlessness
When is levomepromazine used?
= EoL
Acts at vomiting centre and CTZ
SE = drowsiness
When is ondansetron used?
= reduce serotonin release (RT on bowel, surgery of bowel, chemo)
5HT3 antagonist; peripheral (vagal N) and central (CTZ) action
SE = constipation, headache
Give some examples of laxatives and how they work
Senna (stimulant) = reduce bowel transit time
Docusate (softener) = increase water penetration
Na picosulfate (stim/soft)
Lactulose (osmotic) = pulls water in
Movicol/laxido (osmotic) = pulls water in
Glycerin (suppository) = softener
Bisacodyl (suppository) = stimulant
How should breathlessness be treated?
Intractable breathlessness (untreatable, aim is to reduce perception)
- Position patient - use gravity to aid and not hinder weak diaphragm/chest wall muscles
- Air flow across the face: fan or open a window
- Trial of oxygen (if hypoxic)
- Breathing techniques
- Energy conservation
- Distraction
- Anxiety reduction
- CBT
- Goal setting
- NIV
- Small dose of morphine (oromorph 1-2mg)
- Benzodiazepines in anxiety
Pharmacological
- Bronchodilators - trial of salbutamol
- Opioids - morphine 2.5mg/4h
- Corticosteroids - dexamethasone 4-8mg (reduce peri-tumour oedema)
- Benzodiazepines - lorazepam 0.5mg SL PRN/8h (anxiety)
- Oxygen
- Air
What factors affect pain?
State of mind - anger, anxiety, depression, grieving, sleep, lack of understanding, acceptance, relaxation, relief of other symptoms
What is nociceptive pain and how does it feel?
Normal nervous system, identifiable lesion causing tissue damage
Somatic = skin, muscles, bone
- Sharp, throbbing, well localised
Visceral = hollow viscus, solid organ
- Diffuse ache, diff to localise
