Palliative care Flashcards Preview

Year 3 Human Disease > Palliative care > Flashcards

Flashcards in Palliative care Deck (31):
1

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)

2

does palliative care hasten or postpone death?

neither

3

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

4

how many people die annually in the uk

50 000

5

% of where people die in the uk

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

6

7 most common illnesses needing palliative care

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

7

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)

8

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

9

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

10

common symptoms of pts with incurable cancer

-fatigue
-pain
-weakness
-loss of appetite

11

explain oral changes in pts with incurable cancer 5

-dry mouth
-taste changes
-sore mouth
-dysphagia
-hoarseness

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

12

orally related symptoms with incurable head and neck cancer 4

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

13

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

14

3 causes of xerostomia in cancer pts

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

15

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

16

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)

17

2 factors inc oral thrush in cancer pts

-dry mouth
-low immunity

18

3 roles of dentist in oral thrush in cancer pts

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

19

4 ways to manage sore mouth

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

20

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)
-bonjela
-soluble aspirin (local antiinflammatory)
-oramorph (topical analgesic)

21

2 ways to treat oral pain

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

22

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

23

with what illnesses is drooling common (6 examples)

neurological conditions:
-MN
-head and neck cancer
-Parkinson's
-brain tumours
-cerebral palsy
-stroke

24

2 causes of drooling

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

25

5 ways to manage drooling

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

26

2 drugs used to dry secretions and stop drooling

-hyoscine butylbromide
-glycopyrronium

27

what is 'death rattle'

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

28

causes of osteonecrosis of the jaw 3

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

29

5 symptoms of osteonecrosis of jaw

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

30

2 methods to prevent osteonecrosis of the jaws

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

31

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)