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Year 3 Human Disease > Palliative care > Flashcards

Flashcards in Palliative care Deck (31):

functions of palliative care 7

-provide relief from pain and other distressing symptoms
-affirms life and regards dying as natural process
-integrates psychological and spiritual aspects of pt care
-offers a support system to help patients live as actively as possible until death
-offers a support system to help the family cope during the patients illness and in their own bereavement
-enhances quality of life and may also positively influence the course of illness
-come up with end of life strategy (advanced care planning)


does palliative care hasten or postpone death?



when in the disease process is palliative care applicable

early in the course of illness in conjunction with other therapies that are intended to prolong life eg chemo/ radiotherapy, including investigations needed to better understand and manage distressing clinical complications
can also build relationship with pt and have advanced care planning


how many people die annually in the uk

50 000


% of where people die in the uk

58% hospital
18% at home
17% care home
4% hospices (due to low availability)


7 most common illnesses needing palliative care

-cancer (75%)
-chronic lung disease
-chronic liver disease
-end-stage kidney disease
-advanced neurological disorder esp MN
-fraility (old age)


define generalist palliative care

-provided for those affected by life-limiting illness as part of standard clinical pratice by ANY HEALTHCARE PROFESSIONAL providing usual practice
-provided in the community by general practice teams, allied health teams, district nurses, residential care staff, community support services, community paediatric teams
-provided in hospital by general adult/ paediatric medical and surgical teams plus disease specific teams (oncology, respiratory etc)


define specialist palliative care

-palliative care provided by those who have undergone SPECIFIC TRAINING OR ACCREDITATION in palliative care or medicine working in the context of a multidisciplinary team of palliative care health professionals
-builds on general palliative care with higher level of expertise in complex symptom management, psychosocial, cultural and grief and loss support


2 ways palliative care division works

-provides direct care to pts with life limiting illness
-advising other carers eg general palliative care as to when to refer


common symptoms of pts with incurable cancer

-loss of appetite


explain oral changes in pts with incurable cancer 5

-dry mouth
-taste changes
-sore mouth

these symptoms make pts not want to eat --> weight loss and giving up on life- food is one of the few sources of pleasure to a lot of people


orally related symptoms with incurable head and neck cancer 4

-voice changes, eg due to tracheostomy
-difficulty speaking
-head and neck oedema


5 role of dentist in cancer pts

-diagnosis of early suspicious lesions
-prophylaxis (checks pre-radiotherapy, pre-chemotherapy, pre-bone marrow transplant to prevent infections with decreased immunity during tx)
-advice re caries/ periodontal disease during tx (increased risk due to immunosuppressant)
-diagnosis of complications of complications of tx
-advice re oral care


3 causes of xerostomia in cancer pts

-tumour (of salivary glands)
-radiotherapy (less saliva, salive more viscous)
-drugs 4 (opioids, anticholinergics, antipsychotics, anxiolytics)


6 problems of xerostomia

-inc ris of caries
-dry mouth is more acidic --> bacteria grow --> caries
-dry, cracked lips
-angular cheilitis (also due to anaemia)
-problems wearing dentures
-difficulty eating, swallowing, communication


treatment of xerostomia 8

-treat underlying cause where poss (eg change meds)
-good oral care
-frequent sips of water (best)
-ice chips
-pineapple (sialogogue, inc saliva flow rate)
-effervescent vitamin c
-saliva substitutes
-chewing gum (2nd best)


2 factors inc oral thrush in cancer pts

-dry mouth
-low immunity


3 roles of dentist in oral thrush in cancer pts

-advice on management, esp with azole resistance
-advice on denture care (treat dentures too or they re-infect pt)


4 ways to manage sore mouth

-treat underlying cause if poss
-good oral care
-bland foods
-local measures


6 local measures used to treat sore mouth

-gelclair (mechanical barrier)
-difflam spray (LA. bad, causes stinging)
-MuGard oral rinse (mucoadhesive, becomes barrier to mucosa)
-soluble aspirin (local antiinflammatory)
-oramorph (topical analgesic)


2 ways to treat oral pain

-local measures as for sore mouth
-analgesics as per WHO pain/ analgesic ladder


what is the WHO pain/analgesic ladder

1= non-opioid + adjuvant: aspirin/ paracetamol/ NSAID
2= mild- moderate opioid (+non-opioid, adjuvant): codeine
3= strong opioid (+1 and 2): morphine, oxycodone, fentanyl


with what illnesses is drooling common (6 examples)

neurological conditions:
-head and neck cancer
-brain tumours
-cerebral palsy


2 causes of drooling

-overproduction of saliva
-inability to swallow normal amounts of saliva


5 ways to manage drooling

-positioning (on side)
-skin protection (vaseline, pad under face)
-drugs to dry secretions
-radiotherapy to dry mouth (rare)


2 drugs used to dry secretions and stop drooling

-hyoscine butylbromide


what is 'death rattle'

pts breathe through saliva pooled at back of throat (pts unaware but distressing for relatives)


causes of osteonecrosis of the jaw 3

oversuppression of bone turnover:
-multiple myeloma
-bony metastatic disease


5 symptoms of osteonecrosis of jaw

-loosening of teeth
-exposed bone
-numbness or heaviness of jaw
(may be asymptomatic)


2 methods to prevent osteonecrosis of the jaws

-elimation of all sites of potential infection before tx
-avoidance of invasive dental procedures before tx


4 conservative treatments of osteonecrosis of the jaw

-pain control
-debridement of necrotic bone
-tx of infection
-stop bisphosphonates (not much use once disease has begun)