Palliative Flashcards

Question

Features of post op/RT nausea

Answer 1

Serotonin release | Tx = ONDANSETRON

Answer 2

Nausea Faeculent vomiting Abdominal distension Tx = PROKINETIC or LAXATIVES

Answer 3

Specific chemo agents Female Age < 50 Past Hx of N+V

Answer 4

Prevent CINV NK1 antagonist - acts centrally Augments 5HT3 and dexamethasone SE = constipation and headache

Answer 5

``` Disease related - immobility - reduced food-intake/low residue diet - intra-abdominal and pelvic disease Fluid depletion - poor fluid intake - increased fluid loss - vomiting, sweating, fistulae, exudating wounds Weakness - inability to raise intra-abdominal pressure Intestinal obstruction Medication - opioids - diuretics - phenothiazines - anti-cholinergic drugs - recent surgery Biochemical - hypercalcaemia - hypokalaemia ```

Answer 6

``` Stimulant - senna, bisacodyl - reduce bowel transit time Softener - docusate - increase water penetration of stool Stimulant - sodium picosulfate Osmotic - lactulose, movicol, laxido - can cause flatulence and bloating - need to drink reasonable volume of water Suppositories - glycerin - softner - bisacodyl - stimulant ```

Answer 7

``` Colicky pain Vomiting Nausea Abdominal distention Anorexia Bowel sounds increased Overflow diarrhoea Constipation Continuous pain Dry mouth ```

Answer 8

``` Chemo Stent Surgery Gastrostomy NG drainage ```

Answer 9

Anaemia - transfusion PE - LMWH CCF - diuretics, ACEi COPD - bronchodilators Respiratory tract infection - abx Pleural effusion - aspiration, pleurodesis Pericardial effusion - paracentesis, corticosteroids SVCO - stent, RV, steroids Anxiety - CBT, relaxation, benzodiazepines, SSRIs

Answer 10

Mismatch between patient's perceived need to breath (respiratory drive) and ability to do so (physiological capacity)

Answer 11

``` Aim to reduce perception Calm, logical approach Position patient upright Air flow across face Trial of O2 if hypoxic Non-drug approaches if feasible Treat underlying cause Morphine ```

Answer 12

Functional and physical ability - fatigue, increasing weakness, worsening mobility, inability to lift head off pillow Psychosocial and spiritual symptoms - concern for those left behind, fear of unknown, nearing death awareness, increased spiritual focus Reduced food and fluid intake Loss of ability to swallow Bowels and bladder - incontinence, oliguria to anuria urinary retention CVS changes - tachycardia, hypertension, cyanosis, mottling of skin, peripheral oedema Increasing physical symptoms - pain, N+V, resp symptoms, restlessness Resp - SOB, shallow and laboured breathing, apnea Decreasing level of consciousness

Answer 13

Morphine 2.5-5mg sc PRN Midazolam - dyspnoa, agitation Glycopryrronium - secretions Levomepromazine - nausea

Answer 14

``` Constipation - increase fibre and fluid - increase mobility if possible - faecal softeners (docusate sodium) with stimulants (senna) N+V - dopamine antagonist (domperidone, metoclopramide) Drowsiness and sedation Addiction unlikely if used correctly ```

Answer 15

Hard faeces which are uncomfortable to pass - reduced frequency Colicky abdo pain, distention and N+V

Answer 16

Disease related – immobility, decreased food intake, intra-abdominal disease · Fluid depletion – decreased intake, sweating, vomiting · Weakness · Intestinal obstruction · Medication – opioids, diuretics, anti-cholinergics, 5-HT antagonists · Biochemical – hypercalcaemia, hypokalaemia · Psychological – pain of defaecation, lack of privacy

Answer 17

Overflow diarrhoea Acute urinary retention Haemorrhoids

Answer 18

High fibre high fluid diet Increase mobility Stimulants - sodium picosulfate, co-danthramer, senna Faecal softeners - docusate sodium, glycerol Osmotic - lactulose

Answer 19

In cases where we are unsure if patients are going to recover - encourages continued care in aim of recovery while also planning for end of life

Palliative Flashcards

(43 cards)