PALLIATIVE CARE Flashcards
(40 cards)
END OF LIFE CARE
What is palliative care?
- Holistic management of a pt in whom death is likely to be soon + where curative treatment no longer possible
END OF LIFE CARE
What care should be given to an end of life patient?
- Basic care ALWAYS (warmth, comfort, shelter, freedom from pain, cleanliness, PO nutrition + hydration)
- Artificial nutrition + hydration is considered treatment so may be withheld
- Simplify meds, s/c if possible
- Communication v important
END OF LIFE CARE
How does a patient at the end of their life present?
- Sleepy, agitated, drifting in/out consciousness, confusion
- Change in breathing pattern or dyspnoea
- Decreased need for food + fluids
- Loss of bladder or bowel control
- Cold/bluish extremities, mottled skin
- Death rattle
END OF LIFE CARE
What is the death rattle?
Is this dangerous?
- Reduced ability to clear saliva + mucous from back of throat + hypersecretion leading to noisy airway
- No, not painful or uncomfortable
END OF LIFE CARE
What issues presenting at the end of life can be managed pharmacologically?
- Pain
- Dyspnoea
- Agitation + anxiety
- Nausea
- Constipation
END OF LIFE CARE
In terms of managing end of life care, what should be given for regular medication?
Syringe driver
END OF LIFE CARE
What are the aims of palliative care?
Help pt + relatives come to terms with death whilst optimising the quality of time left
END OF LIFE CARE
What does palliative care involve?
MDT approach – physical Sx relief, social, psychological, spiritual + family support
END OF LIFE CARE
what is the management of excessive secretions?
CONSERVATIVE
- avoid fluid overload = stop IV/SC fluids
- educate family that patient is not troubled
MEDICAL
- Hyoscine butylbromide 20mg SC
do not repeat within 1 hr, max dose 120mg in 24hrs
END OF LIFE CARE
In terms of managing end of life care, what should be given for pain + dyspnoea?
MORPHINE 20-30mg modified release per day with 5mg for breakthrough pain (e.g. 15mg modified release morphine BD + 5mg oral morphine for breakthrough pain)
OXYCODONE in mild/moderate renal impairment
ALFENTANIL, BUPRENORPHINE or FENTANYL in severe renal impairment
END OF LIFE CARE
In terms of managing end of life care, what should be given for nausea and vomiting?
Haloperidol 0.5-1.5mg SC
do not repeat within 4 hrs, max dose 3mg in 24hrs
END OF LIFE CARE
In terms of managing end of life care, what should be given for agitation, anxiety, or dyspnoea?
Midazolam 2.5-5mg SC
do not repeat within 1hr, max 4 doses in 24hrs
if not in terminal phase of illness
1st line = haloperidol
other options = chlorpromazine + levomepromazine
END OF LIFE CARE
In terms of managing end of life care, what should be given for constipation?
Start with stimulant laxative (senna) as opiates decrease peristalsis or stool softener if not on opiates, if not suppositories, enemas, PR evacuation
END OF LIFE CARE
In terms of managing end of life care, what should be given for haematuria?
large bleed = admission may be appropriate
non life-threatening bleeds
- encourage increased fluid intake
- exclude UTI
- etamsylate 500mg QDS
- consider referral for palliative radiotherapy
END OF LIFE CARE
In terms of managing end of life care, what should be given for hiccups?
- chlorpromazine
- haloperidol + gabapentin also used
- dexamethasone if hepatic lesions
END OF LIFE CARE
how do you calculate the breakthrough dose for morphine?
1/6 of daily dose of morphine
END OF LIFE CARE
what should be prescribed alongside opioids?
laxatives
END OF LIFE CARE
how is metastatic bone pain managed?
- strong opioids
- bisphosphonates
- radiotherapy
- denosumab
END OF LIFE CARE
what is the management of neuropathic pain?
1st line = amitriptyline, duloxetine, gabapentin or pregabalin
- if 1st line does not work, try one of other drugs
- tramadol may be used as rescue therapy
- topical capsaicin for localised neuropathic pain
WHO ANALGESIC LADDER
what are the steps of the WHO pain ladder?
step 1 = non-opioid (e.g. paracetamol)
step 2 = weak opioid (e.g. codeine + non-opioid)
step 3 = strong opioid (e.g. morphine)
OPIOIDS
give examples of weak opioids
codeine
dihydrocodeine
OPIOIDS
give examples of strong opioids
morphine
diamorphine
oxycodone
hydromorphone
fentanyl
alfentanil
methadone
OPIOIDS
what is the typical starting dose of morphine for opioid naive patients without renal impairment?
20-30mg daily
e.g. 10-15mg oral modified release morphine every 12 hrs
MULTIPLE ORGAN DYSFUNCTION
what is it?
acute dysfunction of two or more organ systems
