Palliative Care Flashcards
Palliative care is
Managing suffering and uncertainy in terminal cases + supports family and patient, affirms life and death as natural processes, provides relief from symptoms and neither hastens or postpones death
Symptom thresholds
The thresholds for reporting symptoms changes over time and depends on how the symptoms are interpreted by the person – this differs depending on the personal and medical context
Can change over a day depending on stressors
Factors which change symptom thresholds
Increase/reduce perceived symptoms –> adequate treatment, explanation and exploration of the symptom and cause, strategies to treat and manage symptom
Decrease/increase perceived symptoms –> inadequate treatment, ignorance, denial, secrecy, psychological/spiritual distress
History of a palliative patient
As normal but take extra time to ask about other symptoms and psychosocial factors – always ask about pain, nausea and dyspnoea.
Family issues or spiritual issues
Management of a palliative patient
general – give information and explain condition, reassurance and empower. Treat any reversible causes. Focus on symptom relief as main priority –> always appropriate
Non-pharmacological symptomatic therapies
Physiotherapy – Breathing control, lymphoedema management techniques, pain management
Acupuncture, psychological strategies, massage and relaxation, complementary therapies
Pharmacological symptomatic therapies
Risk/benefit of any drug prescribed, consider interactions, be proactive in prescribing, rationally choose the best drug and route for the patient
Postural Hypotension
Can be caused by L-DOPA, TCAs, MAOis, anti-hypertensives in general.
Treat with Fludrocortisone (aldosterone mimic) can also be used to test for Conns syndrome.
Converting Oral Morphine to other drugs
1/2 for oral Oxycodone 1/4 for SC oxycodone 1/3 for SC diamorphine 1/2 for oral to SC switch 1/10 of SC diamorphine dose for SC alfentanil PRN SC dose is 1/6 of 24hr SC dose 1/2 for SC morphine
Co-danthrusate
a combination of dantron and docusate which is often prescribed to palliative patients on long term opiates to treat constipation.
Signs of dying
The ‘preactive’ stage which lasts about 2wks, and the active stage which usually lasts about 3days.
Signs of the Preactive stage of dying
Increased agitation/confusion/ changing positons frequently
Withdrawal from social activities
Increased sleep and lethargy
Decreased food/liquids intake
May show periods of apnea
Patient may say they are dying or that they can see people who have already died.
Requests family visit to tie up loose ends
Peripheral oedema
Inability to heal or recover from wounds/infections
Signs of the Active stage of dying
Difficulty in rousing patient or keeping patient roused
Severe agitation or acting crazy
Longer periods of apnea or abnormal patterns of breathing
Inability to swallow fluids
Increased fluid build up in lungs
New onset urinary or bowel incontience - decreaed output
Hypotension, peripheral shutdown or cyanosis
Rigidity of the body or slackness of the jaw
Diagnosing Brain stem death
Criteria for test - deep coma, reversible causes excluded, no sedation and normal electrolytes.
Tests: fixed, unresponsive pupils, absent oculo-vestibular reflexes (Caloric test).
No cough or gap reflex
No response to supraorbital pressure.
No observed independent respiratory effort with sufficient oxygen and CO2 (6.6.5kPa).
Must be performed twice by experienced doctors, one of whom must be consultant and not from the transplant team.
Use of Anti-emetics
Cyclizine for vestibular/cerebral
Metacloprimide/Domperidone for gastric stasis
Dexamethasone for regurgitation/obstruction
Haloperidol for chemical/metabolic
If unknown or multiple use metacloprimide.
