Palliative Flashcards
(3 cards)
How would you change oral morphine to a) morphine in a syringe driver or b)diamorphine in a syringe driver
- Add all doses of oral morphine taken in 24 hours.
Morphine sulphate 60mg bd
20mg tds
total in 24 =( 60 x2) + (20x3) = 180
- Then if using morphine in syringe driver - subcut morph is twice as potent - therefore divide this dose by half. = subcut dose = 90
- Then take 1/6th of subcut dose for breakthrough pain during the day. = 15
- If changing to diamorphine - take 2/3 of the subcut dose. This is your subcut diamorphine dose. = 60
Then one sixth of this would equal your breakthrough dose. = 10
What is the PepsiCola framework for pall care
- Physical symptoms
Pain, delerium, nausea and vomiting, constipation, deprescribing, switch defib off so doesn’t fire during dying process,
- Emotional
- Expectations, Relationships, Security, fears, - Personal
REligious, spiritual, cultural considerations,
Patient, carers agenda
Quality of life
- Social
Organising appropriate support
ACAT team, local palliative care team, Psychologist referral
- Information
informing carers, care-givers
Liaising with specialists
- Control
Advanced care planning - documenting a clear medical plan, exploring patients wishes regarding recusitation, referrals to ACAT, palliative care, home care packages, Iterative process,
Assisting in -Making a will
Appointing medical and legal guardians
Where to die?
Document requests
Dignity/choice/
- Out of hours care
- May need to inform other doctors in practice /on call doc if patient is expected to die
Provide a list of local Palliative services including out of hours numbers
- Late
Organise injectable/syringe driver medicines to be used at home in terminal stages (morphine, midazolam, glycopyryllate).
Comfort measures and spirtual support
Funeral arrangements
- After death
Bereavement follow up
Family support
What are some of the main meds for Community palliative care patients
- Morphine 2.5mg -5mg 1hrly prn for pain or dyspnoea
- Metoclopramide 10mg S/C injection 4 hrly prn
- Haloperidol 0.5 mg S/C injection 4 hrly prn
- Clonazepam (2.5mg/ml) - 2 to 6 drops sublingually prn for severe agitation or if sedation required
