geris/palliative care

Question 1

medications for syringe driver (8) (in groups)

Answer 1

1. antiemetics-
   metoclopramide
   hyoscine butylbromide
2. sedatives -
   haloperidol
   clonazepam
   midazolam
3. analgesia
   morphine
   fentanyl
   hydromorphone

Question 2

Analgesia in palliative care options

Answer 2

• paracetamol (1g po qid) - if able to absorb/tolerate po
• NSAIDS - if able to absorb/tolerate po
  1st line nurofen

- adjuvents- 
amitriptyline/nortriptyline
gabapentin/pregabalin
clonazepam
duloxetine

• opioids

Question 3

Palliative care/end of life symptoms to ask about/mx (6)

Answer 3

Pain
N+V
Agitation/restlessness/confusion
Shortness of breath
Bowel problems (constipation)
Excessive secretions

Question 4

Palliative/terminal phase symptoms ‘PANERO’

Answer 4

Pain
Agitation/confusion
Nausea and vomiting
Emergencies - HB or seizures
Resp symptoms
Other symptoms - r/t specifics of the terminal illness

Question 5

Palliative/terminal phase end of life care symptoms - Rx

drugs dose for subcut

Answer 5

Pain - opioids -
morphine 2.5-5mg 2hrly prn
fentanyl 25-50mcg 2hrly prn
hydromorphone 0.5-1mg 2hrly prn

Agitation -
midazolam 2.5-5mg 2hrly prn
clonazepam 0.2-0.5mg 2-4hrly prn

Nausea and vomiting -
metoclopramide 10mg tds/prn
haloperidol 0.5-1.5mg bd/prn

Emergencies - Hb or seizures - management accordingly

Resp symptoms/SOB -
opioids
secretions - hyoscine butylbromide 20mg 2-4hrly prn

Other symptoms - r/t the illness, manage accordingly

Question 6

Falls and NOF prevention - risk factors (12)

Answer 6

Age>65yrs
hx fall in the last 12months
gait/balance problems
delirium/dementia
vertigo
incontinence
CVD status
Restrained - physical or chemical
Poor footwear
cluttered or poor lit environment
visual defect

Question 7

Falls and NOF prevention - factors to address

medical x4, personal 4x, environmental x5

Answer 7

Medical - polypharmacy, psychotrophic drugs, diuretics and laxatives

Personal - visual impairment, incontinence, nutrition, balance and exercise program

Environmental - footwear, lighting, good flooring, hand rails, mobility aids

Question 8

Falls +/or high falls risk - Mx (6)

Answer 8

Refer to exercise program for strength, balance and CV fitness
surveillance systems - bed alarm, pendant alarm,
Appropriate shoes
Hip protectors
Appropriate use of mobility aids
Adequate Ca + Vit D RDI/supplementation

Question 9

Incontinence screening questions (The 3IC)

Answer 9

1. In the past 3months, have you leaked urine?
   If yes,
2. In the past 3months, did you leaked urine:
   a. when u were performing some physical activity?
   b. when u had the urge that you needed to empty your bladder but could not get to toilet fast enough?
   c. without physical activity and without a sense of urgency?
3. In the past 3months, did you leak urine most often:
   a. when u were performing some physical activity?
   b. when u had the urge that you needed to empty your bladder but could not get to toilet fast enough?
   c. without physical activity and without a sense of urgency?
   d. about equally with physical activities as with sense of urgency?

Question 10

Causes of reversible urinary incontinence

DIAPERS

Answer 10

Delirium
Infection
Atrophic vaginitis
Psychological/pharmacological 
Excessive urine output - polydipsia
Restricted mobility
Stool impaction/constipation

Question 11

Urinary incontinence Ix (4)

Answer 11

Bladder diary for 3 days
urine analysis
urine MCS
USS KUB + post void residual volume

Question 12

Urinary incontinence non-pharmacological mx and general measures (7)

Answer 12

avoid constipation - increase fibre, increase fluids
reduce caffeine and etoh
double void
pelvic floor exercises 
bladder retraining 
assist and prompt with toileting
aids for toileting

Question 13

Overactive bladder tx - drugs, doses, frequency

Answer 13

oxybutinin 2.5-5mg bd-tds
solifenacin 5mg od
mirabegron SR 25-50mg od