Palliative Care

Question 1

why is pancreatic cancer so painful?

Answer 1

the pancreas has a rich supply of afferent sensory fibres that travel superiorly to the celiac ganglia - interruption of these somatic fibres with a celiac plexus block can interfere wth transmission of pancreatic pain

Question 2

describe the WHO analgesic ladder

Answer 2

non opioid +/- adjuvant
opioid for mild to mod +/- adjuvant +/- non opioid
opioid for mod to severe +/- adjuvant +/- non opioid

Question 3

what can you use to help you make the decision of whether to discuss dnacpr with the patient /

Answer 3

dnacpr policy

Question 4

what are the main predictors of negative cpr?

Answer 4

Dependent functional status

• Advanced Metastatic cancer
• Age > 75yrs
• End stage disease

Question 5

in which scenario would you not require to inform the family of a dnacpr form?

Answer 5

There should be a presumption in favour of sensitively informing patients of a clinical DNACPR decision in the context
of their goals of care and possible treatment options unless
(i)it is judged that this conversation would cause the
patient physical or psychological harm,
(ii)the patient refuses discussion, or
(iii)the patient lacks capacity to engage.
Where harm would be caused this explanation must be documented along with a plan to review the patient’s ability
to have this conversation

Question 6

what is mst

Answer 6

slow release morphine sulfate tablet

Question 7

what is a syringe driver?

Answer 7

subcut morphine delivered at specific times throughout the day

Question 8

what is a breakthrough dose?

Answer 8

what you give over and above what the syringe driver is giving when the patient is in pain

Question 9

how to calculate dose of subcut morphine from oral?

Answer 9

Total oral dose 24 hr morphine / 2 = total dose over 24 hrs for subcut morphine

Question 10

how to calculate the breakthrough dose given for subcut morphine?

Answer 10

1/6 of 24hr dose for subcut morphine

Question 11

what do you give for pain and sob in palliative care?

Answer 11

morphine

Question 12

what do you give for distress in palliative care?

Answer 12

midazolam

Question 13

what do you give for nausea in palliative care?

Answer 13

levomepromazine

Question 14

what do you give for resp secretions in palliative care?

Answer 14

buscopan

Question 15

what are the anticipatory medicines prescribed in palliative care?

Answer 15

morphine
midazolam
levomepromazine
buscopan

Question 16

what are just in case boxes?

Answer 16

Used for subcutaneous symptom control in peoples homes to help prevent delays in symptom relief - prescribed at discharge for patients who wish to die at home (nurses administer it but cant prescribe it so saves delays)

Question 17

in death, several Asian countries object to

Answer 17

contact with the dead body

Question 18

jewish patients that have died

Answer 18

should not be touched until 20 minutes after death

Question 19

how to confirm death

Answer 19

Absence of a central (carotid) pulse on palpation

• Absence of heart sounds on auscultation
• Absence of respiratory effort on auscultation
• Absence of pupillary response to light
• Absence of motor response to supra-orbital pressure

Question 20

what do you record in the case notes of a patient who has died

Answer 20

The date and time of death (the time the patient actually died, even if this is according to other staff, rather than observations when the death was verified)
When you were contacted and the date and time of certification, if this is different
A description of what was done to establish death
What was written on the certificate
Whether a pacemaker or other implantable device was present
Whether the GP or Coroner/Procurator Fiscal has been informed of the death.
Whether medical records have been informed.

Question 21

families have ….. days to certify a death

Answer 21

8 days