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3rd Complex Med > Palliative > Flashcards

Palliative Flashcards

1
Q

Describe levels of pain pyramid

A

Etiology, assessment, principles, analgesic, Adjuvants

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2
Q

What Is cancer pain often related to

A

o Direct tumor involvement (bone invasion, nerves plexus)
o Viscera or ducts or vessels (Obstruction or pressure)
o SX, chemotherapy, radiation, constipation, gastric bloating

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3
Q

Describe Key Principles of Pain control

A

By the clock (no delay), educate all involved, individualize, use adjuvants, communicate, PO is best, re evaluate (titration), layer analgesics, scheduled plus breakthroughs (>3 BTD = change in scheduled)

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4
Q

Describe some non pharmacological option for pain control

A

Cutaneous stimulation, Distraction, Relaxation, Positioning, Companioning, Bearing witness

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5
Q

What is the BEST medication for Dyspnea in EOL care

A

Opioids #1 for dyspnea (dec SOB feeling, Dec c02 sensitivity)

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6
Q

What are some basic approaches to reducing dyspnea

A

Reduce demand, control anxiety, tx pathology, control perception of SOB

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7
Q

What are some medications that might be used to control dyspnea

A

Consider Bronchodilators, diuretics, steroids, anti anxiety, 02 (best to trial early in palliation), cough suppression

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8
Q

What should be avoid in the environment for palliative patients with dyspnea

A

Avoid triggers, smoke perfumes instead provide fresh air

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9
Q

Describe non pharmacological interventions r/t dyspnea

A

Positioning of HOB or pillow under arms/loosen clothes to expand chest.
Provide Reassurance, control anxiety

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10
Q

Is hunger common in EOL care?

A

Hunger is not common in EOL. Family may push food, provide a balanced approach

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11
Q

Is thirst common in EOL care?

A

Yes. Dehydration and thirst/ dry mucous membranes common

Artificial hydration (tube feed) may be tempting but should be based on Patient goals

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12
Q

What are the advantage of Dehydration?

A

Benefits: Natural anaesthetic effect, reduction in resp secretions, decreased GI fluid, reduced urine output

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13
Q

What are common effect of poor nutritional intake during EOL

A

Anorexia and cachexia (Muscle Wasting) caused by metabolic disturbance of CA and loss of protein

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14
Q

Describe 3 options for managing delirium

A

Options for delirium MNGMT include :
o Reversal: Pt wishes? And is it possible to reverse
o Sedation: reduced delirium severity through management
o Observation: comfort and support (prepare for sedation)

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15
Q

Describe changes in EOL that may lead to delirium

A

Hypoxemia, Metabolic imbalance, Acidosis, Toxin accumulation due to liver and renal failure, Adverse effects of medication, Sepsis, Disease-related factors, Reduced cerebral perfusion

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16
Q

What is the most basic and important intervention for delirium management

A

Create safe and pleasant environment

17
Q

How common is NV at EOL

A

Very common nearing EOL. Inc in prevalence closer to the EOL

18
Q

Name the 4 sites influencing Nausea and give examples of what might be influencing them

A
  • CTZ- opioids, chemo, Ca imbalance, liver/kidney failure, sepsis
  • Vestibular- tumor/opioids
  • Cortical- anxiety, association, inc icp
  • Peripehral- radiation, chemo, GI irritation/obstruction
19
Q

What are the non pharmacological interventions to confront NV in EOL

A

Environment, oral hygiene, acupuncture, distraction, nutrition, small meals, fizzy drinks

20
Q

What other complications may need to be treated in EOL to deal with NV

A

Electolytes, fluid balance, acid-base, etc

21
Q

Why might Tetrahydrocannabinoids be used in palliative care?

A
  • Nauseaandvomitingfromchemotherapy
  • Chronic pain (neuropathic pain in MS and cancer)
  • Anorexia associated with HIV/AIDS
  • PTSD
  • Anxiety
  • Insomnia
  • Spasticity
  • LowerUrinarytractsymptoms(MS)
  • Improving bladder symptoms associated with MS
  • Neuropathic/nociceptive/mixed pain
  • Chronic daily headache
  • Fibromyalgia
  • Anorexiaandcachexia
  • Spasticity
  • Epilepsy
22
Q

What is Nabilone

A

Nabilone is a synthetic cannabinoid with therapeutic use as an antiemetic and as an adjunct analgesic for neuropathic pain.

23
Q

Describe neuroleptics used in EOL

A

Haloperidol is the gold standard drug therapy for the treatment of patients with delirium near the end of life. It is a longer acting drug

Chlorpromazine may be an acceptable alternative if a small risk of slight cognitive impairment is not a concern.

Methotrimeprazine is effective and used as an alternative to haloperidol. High does used for sedation. Very low doses are used for nausea

24
Q

What is Midazolam and use in EOL

A

Midazolam- Benzo. - frequently used in delirium, but is more helpful for the restlessness aspect. In acute dosing, it is short-acting and rapidly effective.

25
Q

Name some antiemetics that may be used in EOL

A
  • Gravol- antihistamines- vestibular
  • Scopolamine- Anticholinergic- vestibular
  • Ondansetron- 5 HT antagonist – all center
26
Q

What is Hyoscine Butylbromide used for in EOL

A

Anticholinergic- Antidiarrheal

27
Q

Glycopyrrolate used for in EOL

A

anticholinergic- Reduce salivation and reduce excessive respiratory and GI secretions

28
Q

Common changes at end of life

A 
Weakness/Fatigue 
Decreasing Appetite/Food Intake, Wasting 
Decreasing Fluid Intake, Dehydration
Decreasing Blood Perfusion, Renal Failure 
Neurological Dysfunction: 
	Decreasing Level of Consciousness 	
	Terminal Delirium 
	Changes in Respiration 
	Loss of Ability to Swallow
Loss of Sphincter Control 
Loss of Ability to Close Eyes
Changes in Medication Needs
29
Q

What % of patients experience moderate to severe pain in late stages.

A

70%

30
Q

What is cheyne stokes

A

Cheyne–Stokes respiration /ˈtʃeɪnˈstoʊks/ is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease to apnea and repeats

31
Q

3 step of pain control

A

non -opioid + adjuvant
non opioid + opioid and adjuvant
MORE/Stronger opioid plus (level 2)

32
Q

Why use Artificial hydration?

A

Artificial hydration may not be effective or prolong life

Most common physical reasons for initiating AH are to treat delirium caused by opioid toxicity and hypercalcemia

..but generally doesn’t improv quality of life

3rd Complex Med (10 decks)

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