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Flashcards in Palliative care Deck (28)
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1
Q

what are the principles of palliative care

A

improve qol for patients and their families with a life threatening illness
through prevention and relief of suffering, early identification, impeccable assessment, treatment of pain and other problems

physical, psychosocial and spiritual

2
Q

what does approaching the end of life

A

likely to die within 12 months

those facing imminent death and those with advanced, progressive, incurable conditions, general frailty
at risk of sudden death
life threatening conditions caused by sudden catastrophic events

3
Q

what are the key themes for development

A

early identification of patients who may need palliation

advanced anticipatory care planning

care in last hours/days

delivery of effective and timely care

4
Q

what structures have replaced the Liverpool care pathway

A

One chance to get it right

care for people in the last days and hours of life

5
Q

what are the principles of good end of life care

A
open lines of communication 
anticipation care needs
encouraging discussion 
effective MDT input
symptom control 
preparing for death 
providing support for relatives before and after
6
Q

what is generalist palliative care

A

part of routine care delivered by all health and social care professionals, at home, in care or in a hospital

7
Q

what is specialist palliative care

A

can help people with more complex palliative care needs

8
Q

what are some features of pain

A

can be multifactorial
more than one pain
background/ breakthrough/ incident pain
many causes

9
Q

what are the features of bone pain

A

worse on pressure/ weight bearing

10
Q

what are the features of liver pain

A

RIQ tenderness

11
Q

what are the features of raised ICP

A

headache, worse lying down and in the morning

12
Q

what is colic

A

intermittent cramping pain

13
Q

what is neuropathic pain

A

Burning/shooting/tingling/jagging/altered

sensation

14
Q

name some weak opioids

A

codeine, tramadol, dihydrocodeine

15
Q

name some strong opioids

A

morphine, diamorphine, fentanyl, oxycodone

16
Q

what does by the clock pain relief mean

A

analgesics should be given at regular intervals

17
Q

what are some cautions for opioids

A

renal impairment, acute respiratory depression, elderly

however for terminal illness these should not necessarily rule out use of opioids

18
Q

what are the most common side effects of opioids

A

nausea, vomiting, constipation, dry mouth, biliary spasm

opioid toxicity

19
Q

what are the features of opioid toxicity

A
– Shadows edge of visual field
– Increasing drowsiness
– Vivid dreams / hallucinations
– Muscle twitching / myoclonus
– Confusion
– Pin point pupils
– Rarely, respiratory depression
20
Q

what are the features of practical prescribing for morphine

A

controlled release for background pain relief
twice a day

also breakthrough pain relief as required

21
Q

what must be prescribed for constipation during opioid use

A

stimulant and softening laxative
senna, bisacodyl, docusate
etc

22
Q

what antiemetics can be prescribed for nausea associated with opioids

A
metoclopramide
haloperidol (consider QT interval)
23
Q

what can be prescribed for neuropathic pain

A

Amitriptyline/ Gabapentin/ Carbamazepine

24
Q

what can be prescribed for liver capsule pain/ raised ICP

A

Steroids (dexamethasone)

25
Q

what can be given for bowel/bladder spasms

A

buscopan (hyoscine butyl bromide)

26
Q

why are smaller volumes of diamorphine needed

A

more water soluble than morphine

27
Q

what is oxycodone

A

second line opioid

less hallucinations, itch, drowsiness, confusion

28
Q

what is fentanyl patch

A
second line opioid
lasts 72 hours
use in stable pain 
use if oral/SC routes unavailable 
useful if persistant side effects with first line opioids