Palliative **

Question 1

Palliative performance scale
5 objective measurements

Answer 1

LOC
Oral intake
Activity level
Disease evidence
Self care

LOADS

Question 2

Domains of issues to discuss w/ pt

Answer 2

Physical (dyspnea, pain, constipation, nausea)
Emotional issues
Social issues (guardianship, wills, finances)
Spiritual issues
End of life wishes

Question 3

How to manage Bleeding

Answer 3

Anticipatory care plan w/ dark sheets, warm blankets
TXA 1000mg TID
Sedate w/ versed, midaz or lorazepam
Cover with dark blankets/towels

Question 4

How to manage Anxiety

Answer 4

Midazolam
Lorazepam

Question 5

How to manage Bowel obstruction (partial vs complete)

Answer 5

Partial:
Prokinetic: Metoclopramide
Anti-emetic: Haloperidol
Anti-spasmodic: Hyoscine butyl bromide Steroid: dexamethasone 2-4mg

Complete:
Avoid prokinetic
Continue anti-emetic, anti-spasmodic + steroid
Octreotide 100-300mcg SC BID

Question 6

How to manage Constipation

Answer 6

Optimise diet, fibre, hydration + physical activity
PEG 3350 17g OD-BID
Lactulose 15-30ml PO OD-BID
Bisacodyl 5-10mg PO or PR
Glycerin suppository

Question 7

How to manage Delirium

Answer 7

Treat reversible causes
Haloperidol 0.5-1mg SC BID-QID PRN

Question 8

How to manage Dyspnea

Answer 8

Breathing method, position, fan, air flow
Morphine 2.5-5mg SC Q1H
HM 0.5-1mg SC Q1H
Bronchodilators
Lasix 40mg SC Q6H PRN
Dexamethasone 4-8mg PO/SC/IV Q12-24H

Question 9

How to manage Fatigue

Answer 9

Dexamethasone 2-4mg PO/SC/IV once daily

Question 10

How to manage Hypercalcemia

Answer 10

Corrected: calcium + (40 - albumin x 0.2)
Hydration with NS
Pamidronate 90mg IV in 500ml NS @ 125ml/hr Q4w PRN
Zoledronic acid 3-4mg IV over 15mins q3-4weeks

Question 11

How to manage Hiccups

Answer 11

Baclofen 5-20mg Q6-12H
Gabapentin 100mg Q6-8H

Question 12

How to manage Mouth care (thrush, ulcerations, debris)

Answer 12

Thrush: ketoconazole 200mg PO x5 days or nystatin 500,000 units (5ml) swish + swallow QID x 1 week
Ulcerations: lidocaine 2% viscous or 10% spray
Debris: 3% hydrogen peroxide

Question 13

How to manage Myoclonus

Answer 13

Clonazepam 0.5-2md PO QHS
Midazolam 0.5-1mg SC Q4H PRN or continuous SC

Question 14

N/V Chemical cause - causes + rx

Answer 14

(opioid, steroid, chemo, metabolic)
Haldol 0.5-1.5mg PO/IV/SC/ BID-TID
Ondansetron 4-8mg PO/SC/IV

Question 15

N/V cortical cause - causes + rx

Answer 15

(anxiety, pain, emotional fear)
Lorazepam 0.5-1mg SL QID PRN
Nozinan 3.125-6.25mg PO/SC Q8H

Question 16

N/V cranial cause - causes + rx

Answer 16

(increased ICP, meningeal infiltration, radiation)
Gravol 50mg PO/SC/PR Q4H
Dexamethasone 8mg

Question 17

N/V vestibular cause - causes + rx

Answer 17

(motion induced, drugs, cerebral tumor)
Gravol 25-50mg PO/IM/IV Q4H

Question 18

N/V visceral cause - causes + rx

Answer 18

(bowel obstruction, constipation, mesenteric)
Gravol 50mg PO/SC/PR Q4H

Question 19

N/V gastroparesis cause - causes + rx

Answer 19

(drugs, ascites, hepatomegaly)
Metoclopramide 10mg PO/ IV/ SC QID (w/ meals + QHS)
Domperidone 10-20mg PO QID (w/ meals + QHS)

Question 20

How to manage resp secretions

Answer 20

Hyoscine 0.4-0.6mg SC Q4H
Glycopyrrolate 0.2-0.4mg SC Q4H

Question 21

How to manage anorexia

Answer 21

RD
Nutritional support
Megestrol 160-800mg once daily
Dexamethasone 4-8mg PO QAM + PPI
Domperidone or metoclopramide 10mg PO TID

Question 22

How to pronounce death

Answer 22

Confirm and Document
Check ID bracelet
No spontaneous respiration
No response to tactile stimulation and pain (pressure on nailbed)
Absent breath sounds, heart sounds
Absent carotid pulse
Fixed pupils, non-reactive to light
Time of death
Notify family if not present

Question 23

Hypercalcemia rx in palliative care

Answer 23

fluids, bisphosphonate, calcitonin/ steroids

Question 24

SVC obstruction sx

Answer 24

SOB, feeling of fullness in head, swelling of upper body/ face, hoarseness, CP at rest

Question 25

SVC obstruction rx

Answer 25

dexamethasone, opioids, benzos, stent/ chemo/ RT