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Flashcards in Palliative Care Deck (30):
1

What are the three truths about dying?

1. we dont really mind death
2. our biggest loss is emotional
3. our biggest hope is spiritual

2

Why are we afraid of death?

- in the last 100 years we have quarintiened death
-people are now taken to a hospital and a sheet placed over them when they die and then to make sure they are gone they are cremated

3

Why is death good?

- when people get old they lose all function and cannot live by themselves and thus are misserable

4

What are the ECOG ratings?

0 = fully active
1 = restricted in physically strenuous activity
2 = self care but only for 50% of day
3 = limited self care for less then 50% of the day
4 = completely disabled
5 = dead

5

What happens in the last week of life?

- weakness and fatigue
- lack of appetite
- lack of interest in surroundings
- pain
- restlessness and confusion

6

What happens in the last hours of life?

- all die of circulatory failure
- brain, kidney, liver and skin
- the end is more distressing for the family than the patient

7

Define death?

- abscence of life

8

What is medical death?

- absent pupil reflex
- no pulse, respiration
- no brain activity

9

What are the considerations of the person?

- social
- ethical
- health
- financial
- personal
- other

10

Define palliative care

- to cure sometimes, to relieve often, to comfort always
- easing the severity of pain associated with disease or illness without removing the cause

11

What are some factos associated with pallliatice care?

- affirms life and treats dying as a normal proccess
- neither hastens nor postpones death
- provides relief from pain and other distressing symptoms

12

What does palliative care integrate?

- physical, psychological, social, emotional and spiritual aspects of care with coordinated assessment and management of each person' needs

13

What are the generalised effects of cancer?

- weakness
- fatigue
- weight loss
- increasing pain

14

What are the specific effects of cancer?

- pain
- bleeding
- swelling
- blockage
- metabilc e.g. raised calcium
- mass effects
- fungating wound

15

What are the effects of morphine?

- drawsiness and impaired concentration
- constipation
- nausea and vomitting

16

What is temporal effects?

- patient feels fine now but later on feeling severly worse

17

What are other factors to consider in palliative patient care?

- prognosis
- bucket list
- advanced directives
- financial planning
- special events
- funeral planning

18

What is the role of RT in palliative care?

- make you feel better but RT can make you feel worse first
- need to think about patient shouldn't just treat for the sake of treating

19

What are the aspects to decide if RT is used for palliative patient?

- will RT help
- prognosis (if patient is going to die tomorrow then dont treat)
- patient factors
- alternatives (e.g. is a stent possible instead of 10 days of RT)
- timing
- dose fractionation

20

What are some indications of SC compression?

- pain increasing
- weakness
- bladder and bowel dysfunction

21

What is the RT role in SC compression?

- 1 to 10 days
- 80:20 rule
- side effects: nausea and fatigue

22

What happens in an emergency SC compression?

- rapid onset of symptoms leading to irreversible paralyss
- early intervention allows for preservation of neruological function in up to 80% of people
- reduces pain

23

What is the managmenet of an emergency SC compression?

- steroids
- emergency RT to 30Gy in 10 fractions
- pain management

24

What are the challenges in treating CNS?

PHYSICAL
- pain, confusion, immobility, neurological, other cancer effects (steroids, morphine)

EMOTIONAL
- drug effects, depression, cycle of loss, anger, fear

SPIRITUAL
- faith or lack of faith, miracles

PRACTICAL
- mask, timing of treatment, family, conflicitng interests, swelling from steriods

25

What are the beam arrangment options for spine RT?

- ant and post
- 2 post oblique, 1 lat, 1 ant oblique and 1 ant

26

What are the common side effects from RT and how are they treated?

- nausea: zofran
- diarhhoae: gastro-stop
- burning: skin lotion
- muscositis: opioids
- hair loss: none
- fatigue: none
- oesophagitus: mylanta

27

How do we manage palliative patients?

- empathy
- allow space
- understand journey: changes will occur
- faimly members are also experiencing loss so may be part of care process

28

What are the emotions realted to dying?

- fear
- guilt
- loss and grief
- hope

29

What are the three factors that make up the "whole person"

- physical
- spiritual
- emotional

30

What are the 5 stages of emotion?

- fear
- anxiety
- guilt
- loss and grief
- hope