Palliative care Flashcards Preview

Medicine for the elderly > Palliative care > Flashcards

Flashcards in Palliative care Deck (14)
Loading flashcards...
1
Q

aim of palliative care

A

care for incurable diseases to improve quality of life - prolong, symptoms management - offered at any point after diagnosis

2
Q

mimics of death

A
opioid and drug toxicity
sepsis or infection
hypercalcaemia
AKI
hypoglycaemia
3
Q

changes as approach death

A
weakness
fatigue
lost interest in food and fluids
breathing changes
dry mouth
anxiety
pain
4
Q

anticipatory medications which can be given

A
pain/SOB -> morphine
distress -> midazolam
nausea -> levomepromazine
secretions -> buscopan
dont give IV fluids as risk of fluid overload
5
Q

general mx of end of life

A

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

6
Q

pain ladder

A

step 1 -> non-opioid (aspirin, paracetamol, NSAID) +/- adjuvant
step 2 -> weak opioid (codeine) +/- non-opioid +/- adjuvant
step 3 -> strong opioid (morphine) +/- non-opioid +/- adjuvant

7
Q

what targeting when giving pain relief

A

baseline constant pain -> slow release morphine (MST or Zomorph)
breakthrough pain -> immediate release morphine PRN - oramorph or sevredol

8
Q

how to calculate breakthrough pain dose of morphine

A

1/6 of total background dose

9
Q

what opioid to give if severe renal impairment and why

A

fentanyl or alfentanil as morphine is renally secreted so would build up and cause toxicity

10
Q

symptoms of morphine toxicity

A

hallucinations, myoclonus, drowsiness, respiratory depression

11
Q

what to do if respiratory depression due to morphine toxicity

A

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

12
Q

electronic advance care plans outline what

A

CPR decisions
preferred place of care and death
anticipatory medications

13
Q

how to confirms death

A
[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
14
Q

must register death in what time frame

A

in 8 days