Palliative care in gynaecological malignancy Flashcards
(36 cards)
What are the physical symptoms of gynaecological malignancy?
- pain
- nausea and vomiting
- constipation
- bleeding
- treatment related
What are the social complicatons of gynaecological malignancy?
- altered body image
- fertility issues
What are the emotional complicatons of gynaecological malignancy?
Fear
Worry about the future
What are the spiritual complicatons of gynaecological malignancy?
Why me
Why now
family and carers
Describe the history for N&V?
- triggers, volume, pattern
- exacerbating and relieving factors, including individual and combinations of drugs tried and routes used
- bowel habit
- medication – consider drugs that may:
- contribute to the nausea and vomiting
- cause harm
- not take effect due to the nausea and vomiting
- exclude regurgitation as this will require a different approach. If suspected consider seeking advice
- check for other concurrent symptoms.
Describe examination for N&V
- general review for signs of dehydration, sepsis and drug toxicity
- central nervous system
- abdomen (for example organomegaly, bowel sounds, succussion splash)
- check temperature, pulse and respiration
What is succussion splash?
- sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation
- It reflects the presence of gas and fluid in an obstructed organ, as in gastric outlet obstruction.
What are the cerebral cortex causes of nausea and vomiting?
Emotions, sight, smell, raised ICP, anxiety
What are the chemoreceptor trigger zone causes of nausea and vomiting?
Metabolic (uraemia, ca) drugs
What are the vestibular centre causes of N&V?
Motion
What are the GI tract causes of N&V?
GI distension, stasis, tumour, mass, constipation, XRT
What receptors are targeted in cerebral cortex to prevent stimulation of the vomiting centre?
What drugs do this?
GABA, NK1, 5HT
Dexamethasone, aprepitant, benzodiazepines
What receptors are targeted in the vestibular centre to prevent stimulation of the vomiting centre?
What drugs do this?
H1, ACh
Cyclizine, levomepromazine, Hyoscine
What receptors are targeted in the CTZ to prevent stimulation of the vomiting centre?
What drugs do this?
D2, 5HT, ACh
Haloperidol, levomepromazine, ondansetron
What receptors are targeted in the GI tract to prevent stimulation of the vomiting centre?
What drugs do this?
5HT, D2, ACh
Metoclopramide, levomepromazine, odensetron, dexamethasone
caution in obstruction
What are the causes of cerebral disease induced N&V?
Compression / irritation by tumour, raised ICP, anxiety
What is the clinical picture of cerebral disease causing N&V?
Worse in morning
Associated headache
What are the causes of impaired gastric emptying induced N&V?
Locally advanced cancer, drugs, radiotherapy damage to gut, autonomic neuropathy
What is the clinical picture of impaired gastric emptying causing N&V?
- not usually nauseated
- then very nauseated
- large volume vomits
- feels better after being sick
What are the causes of oncological treatment induced N&V?
Chemotherapy
Radiotherapy
What is the clinical picture of oncological treatment causing N&V?
Predictable from history
Often nausea is main complaint
What are the causes of chemical/metabolic induced N&V?
Medication, advanced cancer, sepsis, kidney or liver impairment, biochemical
What is the clinical picture of chemical/metabolic disturbance causing N&V?
Think: calcium, sodium, magnesium, urea
Persistent nausea
Little relief from vomiting
What is the non-pharmacological treatment for N&V?
- Regular mouth care
- Keep bowels moving to avoid constipation contributing
- Encouraging small meals, rather than large meals
- Avoid cooking or preparing food
- A calm and reassuring environment
- Acupressure bands (for example Seaband®)
- Acupuncture
- Psychological approaches
