aim of palliative care
care for incurable diseases to improve quality of life - prolong, symptoms management - offered at any point after diagnosis
mimics of death
opioid and drug toxicity sepsis or infection hypercalcaemia AKI hypoglycaemia
changes as approach death
weakness fatigue lost interest in food and fluids breathing changes dry mouth anxiety pain
anticipatory medications which can be given
pain/SOB -> morphine distress -> midazolam nausea -> levomepromazine secretions -> buscopan dont give IV fluids as risk of fluid overload
general mx of end of life
only continue essential medications and switch to non-oral route as will loose swallow (syringe driver)
anticipatory medications ready
look out for urinary retention
stop routine obs and monitoring and remove unused equipment
appropriate environment
hollistic support for pt and fam
pain ladder
step 1 -> non-opioid (aspirin, paracetamol, NSAID) +/- adjuvant
step 2 -> weak opioid (codeine) +/- non-opioid +/- adjuvant
step 3 -> strong opioid (morphine) +/- non-opioid +/- adjuvant
what targeting when giving pain relief
baseline constant pain -> slow release morphine (MST or Zomorph)
breakthrough pain -> immediate release morphine PRN - oramorph or sevredol
how to calculate breakthrough pain dose of morphine
1/6 of total background dose
what opioid to give if severe renal impairment and why
fentanyl or alfentanil as morphine is renally secreted so would build up and cause toxicity
symptoms of morphine toxicity
hallucinations, myoclonus, drowsiness, respiratory depression
what to do if respiratory depression due to morphine toxicity
measure RR throughout
reduce dose or switch to another opioid
give naloxone in small dosese every 2mins - careful as don’t want to reverse completely as will then be in severe pain
electronic advance care plans outline what
CPR decisions
preferred place of care and death
anticipatory medications
how to confirms death
[5 mins to assess minimum] absense of pulse (>1min same for following) absense of heart sounds absense of respiratory sounds no response to pain fixed and dilated pupils
must register death in what time frame
in 8 days
