Palliative care Flashcards
(22 cards)
what is palliative care
doing everything possible to support someone’s quality of life in the context on an incurable illness - holistic care and symptom control
what is ACP
advanced care plans - created by GPs and shared with other professionals in patients care eg. no resuscitation, no hospital admission ect.
true or false: palliative care is for dying patients only
false
includes care of the dying by can be offered at any point from diagnosis
where to find info on symptom management in palliative care
Scottish palliative care guidelines
pain management step 1: mild pain treatment
paracetamol 1g 4x daily
and/or NSAID eg naproxen 500mg 2x daily
and/or other adjuvant
pain management step 2: moderate pain
codeine 30-60mg 4x daily
and/or adjuvant
pain management step 3: severe pain
stop codeine and switch to strong opioid - usually morphine
and/or adjuvant
what is modified release morphine
12 hr preparation given in morning and at bedtime - manages background pain
MST or zomorph
what opioid is used to manage breakthrough pain
immediate release morphine (taken as required)
oramorph (liquid) or sevredol (tablet)
how do you calculate the breakthrough dose in comparison to the background dose
the background dose divided by 6
what are some symptoms of opioid toxicity
hallucinations
vivid dreams
myoclonus - sudden jerking movements in sleep
drowsiness
treatment for opioid toxicity
check renal function - impaired renal function can cause morphine toxicity
if decrease renal function seek advice and switch to a different opioid
if missed becomes respiratory depression
Naloxone is used to reverse morphine v quickly
how is naloxone used to reverse opioid toxicity
dilute the naloxone and give in tiny doses until respiratory rate improves - otherwise all their pain will come back at once
what is a second line strong opioid to morphine
oxycodone (twice as strong as morphine so dose needs halved)
clues to tell you if someone is near the end of life
Worsening weakness and performance status
worsening physiological status with no reversibility
struggling to manage oral medicines
losing interest in food and fluid
sleeping more, eventually unconsciousness
what are some treatable conditions which mimic dying
Opioid/drug toxicity Sepsis Hypercalcaemia AKI Hypoglycaemia
things to ensure when the patient is dying
Only essential medications continued
Oral medications covered to alternative route if no swallow
Anticipatory medications prescribed for common problems
Don’t miss urinary retention as cause of agitation
Stop routine obs/monitoring/take out unused cannulas
Appropriate environment and equipment in place
what are syringe drivers
give smooth delivery or meds via continuous subcutaneous infusion
infused over 24 hours and changed daily - portable
what is the anticipatory prescription for pain and SOB in dying people
morphine 2mg scut
what is the anticipatory prescription for distress and SOB in dying people
midazolam 3mg scut
what is the anticipatory prescription for nausea in dying people
levomepromazine scut
what is a just in case box
used for scut symptom control in peoples homes to prevent delays in symptoms relief
