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MD4001 - Clinical > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

Define palliative care

A

Palliative Care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

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2
Q

Define approaching the end of life

A
  • Likely to die within the next 12 months
  • Those facing imminent death and those with:
    • Advanced, progressive, incurable conditions
    • General frailty (likely to die in 12 months)
    • At risk of dying from sudden crisis of condition
    • Life threatening conditions caused by sudden catastrophic events
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3
Q

What are the principles of delivering foo end of life care?

A
  • Open lines of communication
  • Anticipating care needs and encouraging discussion
  • Effective multidisciplinary team input
  • Symptom control – physical and psychospiritual input
  • Preparing for death – patient and family
  • Providing support for relatives both before and after death
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4
Q

Describe pain experienced by those facing end of life

A
  • Can be multifactorial
  • Most patients have more than one pain
  • Background/Breakthrough/Incident
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5
Q

Describe the physical causes of pain for those nearing the end of life

A
  • Cancer related (85%)
  • Treatment related
  • Associated factors-cancer and debility
  • Unrelated to cancer
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6
Q

What are the main types of pain syndromes?

A
  • Bone pain
    • Worse on pressure or stressing bone/weight bearing
  • Nerve pain (neuropathic)
    • Burning/shooting/tingling/jagging/altered sensation
  • Liver pain
    • Hepatomegaly/right upper quadrant tenderness
  • Raised intracranial pressure
    • Headache (and/or nausea) worse with lying down, often present in the morning
  • Colic
    • Intermittent cramping pain
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7
Q

Draw the WHO pain ladder

A
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8
Q

What is an adjunct medication?

A

other medications that have their clinical use in another area but have benefit in analgesia

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9
Q

What is the 1st lune strong opioid of choice?

A

Morphine

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10
Q

What are the indications for a strong opioid?

A
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11
Q

What are the main actions of strong opioids?

A
  • Opioid receptor agonist (µ-receptors)
  • Centrally acting
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12
Q

How are strong opioids usually administered

A
  • Enterally – oral/rectal
  • Parenterally – IM/SC injection
  • Delivery via syringe driver over 24 hours
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13
Q

What are the principles involved in starting strong opioids?

A
  • Principles to go by –> moving on the ‘Step 3’
  • Stop any ‘Step 2’ weak opioids
  • Titrate immediate release strong opioid
  • Convert to modified release form
  • Monitor response and side-effects
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14
Q

Outline modified release opioids

A
  • Background” pain relief
  • Either twice daily preparation at 12hourly intervals
  • Or one daily preparation at 24hourly intervals
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15
Q

Outline immediate release opioids

A
  • Breakthrough’ pain
  • As required (PRN)
  • E.g. Oramorph liquid/Sevredol tablets
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16
Q

Describe diamorphine and how it is used

A
  • Semi-synthetic morphine derivative
  • More soluble than morphine –> smaller volumes needed
  • Can be used for parenteral administration (injection/syringe driver)
17
Q

What is the main reason for switching opioids?

A

Opioid sensitive pain with intolerable side-effects

18
Q

What is the main 2nd line opioid?

A

Oxycondone

19
Q

Why are patients given oxycodone given to replace morphine?

A

Less hallucinations, itch, drowsiness, confusion

20
Q

Why are patients prescribed a fentanyl patch?

A
  • Second line opioid
  • Lasts 72 hours
  • Only use in stable pain
  • Useful of oral and subcutaneous routes not available
  • Useful if persistent side-effects with morphine/diamorphine
21
Q

What are the most common side effects of opioids?

A
  • Nausea and Vomiting
  • Constipation
  • Dry Mouth
  • Biliary spasm
  • Watch for signs of opioid toxicity
22
Q

How is opioid induced constipation managed?

A
  • Stimulant and softening laxative
  • Senna/Bisacodyl + Docusate
  • Macrogol e.g. Laxido/Movicol
  • OR DO-Danthramer alone
23
Q

How is opioid induced nausea managed?

A
  • Antiemetic
  • Metoclopramide
  • Haloperidol (consider QT interval)
24
Q

What are the main signs of opioid toxicity?

A
  • Shadows edge of visual field
  • Increasing drowsiness
  • Vivid dreams/hallucinations
  • Muscle twitching/myoclonus
  • Confusion
  • Pinpoint pupils
  • Rarely, respiratory depression
25
Q

What are the adjunct medications used for liver capsule pain/raised ICP?

A
  • Steroids (e.g. dexamethasone)
  • Remember to consider gastroprotection
26
Q

What is the adjunct medication for neuropathic pain?

A

Amitriptyline/Gabapentin/Carbamazepine

27
Q

What is the adjunct medication for bowel/bladder spasm?

A

Buscopan (Hyoscine Butylbromide)

28
Q

What is the adjunct medication used in bone pain/soft tissue infiltration?

A

NSAIDs/Radiotherapy for bony metastases

29
Q

What is the main functions of a syringe driver?

A
  • Delivery over 24 hours – usually subcutaneous
  • Useful when oral route inappropriate
  • Often useful for rapid symptom control
  • Multiple medications can be added
  • Stigma of being on a ‘pump’
30
Q

What are the four elements that need to be considered when managing total pain?

A
  • physical
  • social
  • spiritual
  • psychological
31
Q

What is psycho-spirutal distress?

A

the impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, nature, or a power greater than oneself

32
Q

What can psychospiriutal distress be expressed as ?

A

expressed as – or magnify the intensity of – physical symptoms

33
Q

When may spiritual distress occur?

A

may occur when the individual is faced with challenges that threaten an individual’s beliefs, meaning, or purpose

34
Q

When is psychospiritual distress likely to occur?

A
  • At diagnosis
  • At home after initial treatment
  • At disease progression or recurrence
  • At the terminal phase
35
Q

What are the key issues in managing psycho-spiriutal distress?

A
  • Encouraging hope, purpose and meaning
  • Respecting religious/cultural needs
  • Affirming the patient’s humanity
  • Protecting the patient’s dignity, self-worth and identity
  • Encouraging relationships
  • Encouraging forgiveness/reconciliation
  • Refer to colleagues in wider MDT/specialist services
36
Q

What are the main types of grief

A
  • Anticipatory Grief
  • Non-complex (normal) Grief = 90-94%
  • Complex/Unresolved Grief = 6-10%
37
Q

What is grief not a measurement?

A

Grief is not a measure of the relationship between the bereaved and the deceased

MD4001 - Clinical (9 decks)

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