Flashcards in Palliative Care Deck (31)
What does palliative care focus on?
QoL of patients and their families
Prevention and relief of suffering
What proportion of patients die during their admission to hospital?
Name 5 symptoms that need to be controlled in end of life care
What affects pain?
Psychological (fear, anxiety, anger)
Social (carer strain, fear)
Spiritual (anguish, suffering, hopelessness)
What is the WHO pain ladder?
The steps taken as pain worsens
Start with non opioid +/- adjuvants (paracetamol, NSAIDs)
Progress to mild opioid +/- non opioid +/- adjuvant
Then to strong opioid
What does PRN mean?
As needed (pro re nata)
Dosing of opioids
Regular doses of immediate release opioid + PRN 1/6 of total
SE of opioids?
Nausea, vomiting, constipation, sweat, itch
6 signs of opioid toxicity
Pin point pupils
Respiratory depression (late)
How do you deal with opioid toxicity?
Due to problems in renal excretion/liver metabolism?
Switch to different opioid?
Opioid antagonist (naloxone)
What opioid is best for renal insufficiency?
What is the most common life threatening metabolic disorder encountered in patients with cancer?
8 signs/symptoms of hypercalcaemia
Nausea and vomiting
How do you manage hypercalcaemia?
Bisphosphonate infusion (pamidronate)
What pattern of nausea and vomiting does someone experience in bowel obstruction?
Little nausea, large volume vomit, better after vomit
What pattern of nausea and vomiting does someone experience in drug induced n&v
Constant nausea, little vomit, no relief after vomit
What causes nausea?
Taste, candida, secretions
Bowel stasis, gastritis, constipation, obstruction
Fear, smell association
What receptors does the vomiting centre have?
What receptors does the inner ear have?
What receptors does the CTZ have?
What receptors does the gut have?
What commonly causes bowel obstruction in palliative patients
Post irradiation fibrosis
1º tumour in bowel
Infiltration into mesentery/muscle -> peristalsis affected
Signs and symptoms of complete bowel obstruction
No bowel action for a while
Large volume faecalent vomits
Palliative treatment for bowel obstruction
Anticholinergics (decrease secretions)
Somatostatin analogues (decrease secretions)
Laxatives (improve gut motility)
NG tube as last resort]Stents/bypass surgery can be of benefit
Name 3 antiemetics
Name 2 antipasmodics
5 symptoms of spinal cord compression
What level does spinal cord compression become cauda equina syndrome?
Treatment of spinal cord compression?
High does steroid, radiotherapy+/- surgery