Palliative Care Flashcards
(27 cards)
Who provides palliative care?
Hospices
Hospital
Community
Specialist palliative care services such as macmillan day care
Which types of patients may receive palliative care?
Incurable cancers Progressive organ failure (COPD, PF, heart failure, renal failure) Progressive neurological disorders Dementia Frailty Multimorbidity
What symptoms are usually controlled in palliative care?
Pain Fatigue/weakness Poor mobility Breathlessness Poor appetite/wgt loss Sore/dry mouth N&V
List the steps of pain management
Step 1: Mild pain
Paracetamol and/or NSAID and/or other adjuvant
Step 2: Moderate pain
Codeine or co-codomol (codeine combined w/ paracetamol)
Step 3: Severe pain
Stop codeine and switch to strong opioid (usually morphine) Use in conjunction w/ paracetamol/NSAID/adjuvants
Is morphine addictive?
No if used solely for pain management and not used to achieve a feeling of ‘reward’
Can you get withdrawal symptoms from morphine?
Yes if suddenly stopped or reversed
What severe side effect can occur with morphine is not used correctly?
Respiratory depression
Which drug can reverse morphine very quickly?
Naloxone
What are symptoms of opioid toxicity?
Hallucinations, myoclonus and drowsiness
What are the two types of morphine?
Modified release (MR)- background pain (Twice daily tablets) Immediate release (IR)- breakthrough pain (PRN tablet (sevredol) or liquid (oromorph)
How do you convert a dose of codeine to morphine?
Divide codeine dose by 10
E.g. codeine 60mg four times a day (240mg daily) becomes 24mg morphine equivalent
If a patient is taking 15mg of codeine four times a day, what would that convert to in MST and oramorph?
MST 5mg twice daily
Oramorph 2mg PRN
If a patient is taking MST 50mg twice daily what does that convert to?
Breakthrough dose= 100mg/ 6
=15mg oramorph
What does palliative care involve?
Pain and symptom control
Emotional and psychological support
Advanced care planning (helping to plan ahead)
Care of the dying patient
What is advance care planning? (ACP)
Thinking ahead to avoid crisis decision making near end of life
When admitting an elderly person to hospital you should always check their clinical portal for what>?
A Key Information Summary (KIS) which identifies patients with palliative care needs
What does a Key Information Summary include?
Resusciatation wishes/decisions
Preferred place of care and death
Anticipatory/ ‘Just in Case’ medications
Power of Attorney
What are recognisable signs of dying?
Worsening/weakness
Struggling to manage oral medicines
Losing interest in food/fluid
Sleeping more
Which diseases can mimic the dying process?
Hypoglycaemia Sepsis Delirium Hypercalcaemia Opioid/drug toxicity AKI
What changes should be made to medication in end of life?
Stop all non-essential medications (e.g. statins, anticoagulants)
Oral meds converted to alternative route (no swallow)
Anticipatory meds prescribed
Urinary retention could be a cause of agitation
Stop routine obs/monitoring
What should oral routes be swapped for?
Syringe drivers (infused over 24 hours, up to 3 drugs at a time)
How many times more potent is morphine when given SC?
Twice as potent when given SC
How do you work out the SC dose of morphine from PO dose?
Divide PO dose by 2= SC dose
If a patient is given oral MST 10mg bd, what is the SC dose?
SC morphine 10mg over 24 hours
