Term
|
Definition
| active total care of patients with incurable progressive life threatening condition but multi professional team |
|
|
Term
| what does palliative mean in latin? |
|
Definition
| it means Pallium.. this means a cloak thus in palliative care symptoms are cloaked with rx whose primary aim is to promote comfort |
|
|
Term
| define the difference between end of life and terminal care |
|
Definition
end of life: in their last 6-12 months of life
terminal care: they are going to die in the next few weeks or days |
|
|
Term
| what is the difference between a life limiting and a life threatening condition? |
|
Definition
life limiting: there is no reasonable hope of cure, the person will die from it
life threatening: curative treatment may be feasible but can fail such as cancer |
|
|
Term
| Total pain was proposed by Cicely saunders. what are 4 dimensions? |
|
Definition
Physical
psychological
Social
Spiritual |
|
|
Term
| what does quality of life mean in palliative care? |
|
Definition
it is what a person says it is.
palliative care is about quality of life and include rehabilitation |
|
|
Term
| what is end of life care? |
|
Definition
support for people who are in the last months or years of their life.
it should help you to live as well as possible until you die, and to die with dignity. |
|
|
Term
| what does 'life limiting' mean |
|
Definition
| a condition for which there is currently no cure available and the likelihood is that the condition will lead to the death of the pt. |
|
|
Term
| what does 'terminal' mean? |
|
Definition
| the condition cannot be cured or adequately treated and it is reasonably expected to result in death of the pt within a short period of time. |
|
|
Term
| what does palliative mean? |
|
Definition
| It is holistic care emphasising emotional, social and spiritual needs. This is taken hand-in-hand with a progressive approach to managing end-of-life symptoms medically. |
|
|
Term
| palliative care is just not cancer. what other conditions may require palliative care |
|
Definition
HF
COPD
dementia and neurological disorders
organ failure |
|
|
Term
| WHO definition of palliative care |
|
Definition
| An approach thats improves QofL of people and their families who are facing problems due to life threatening illness. This is done through prevention and relief of suffering by early identification and impeccable assessment and rx of pain and other problems, physical, psychosocial and spiritual. |
|
|
Term
when was the first hospice opened?
which women is associated with the origins of palliative care? |
|
Definition
St Christopher's Hospice in 1967
Dame Cicely Saunders |
|
|
Term
| what are the 2 distinct groups of health and social care professions involved in providing palliative care? |
|
Definition
non specialists - day to day stuff.
specialist palliative care providers - consultants in palliative care or nurse specialists. |
|
|
Term
| how much of the adult hospice income comes form the NHS? |
|
Definition
35%
the rest is from voluntary organisations, charities and local fundraising. |
|
|
Term
| outline psychological consequence of terminal illness for pts and their families. |
|
Definition
emotional adjustments - diagnosis, impact of disease, rx, effect on relationships
communication - pts and families may find it hard to talk openly about it. especially to children
symptoms and SE of disease/rx -
sex and sexuality
work, mortgages, pensions, loans
dietary advice
travelling |
|
|
Term
| according to SIGN what is the break through dose of morphine? |
|
Definition
|
|
Term
| which opioids are preferred in pts with CKD? |
|
Definition
alfentanil
fentanyl
buprenoprhine |
|
|
Term
| when increasing the dose of opioids what increment should the dose be increased by? |
|
Definition
|
|
Term
| how do you convert PO codeine to PO morphine? |
|
Definition
|
|
Term
| which drug causes less sedation, vomiting and pruritis than morphine but more constipation? |
|
Definition
|
|
Term
what is given in palliative care to rx hiccups. what is incensed. what else can be used?
what if the pt has got hepatic lesions and hiccups? |
|
Definition
Chlorpromazine is licensed to rx intractable hiccups
Haloperidol and gabapentin are also used
dexamethasone is used if there are hepatic lesions |
|
|
Term
| what is used to treat agitation and confusion in palliative care? |
|
Definition
Haloperidol. others: chlopromazine, levomepromazine.
In the terminal phase of the illness this is treated with midazolam. |
|
|
Term
| what might be the cause of confusions and agitation in palliative care other than dying? |
|
Definition
hypercalcaemia
infection
urinary retention
medication. |
|
|
Term
| name the 5 steps of grief reaction |
|
Definition
Denial
Anger
Bargaining
Depression
Aceeptance |
|
|
Term
| in the UK when has palliative care been a specialty since? |
|
Definition
|
|
Term
| who is a palliative care patient? |
|
Definition
| there is not a clear cut between disease modifying therapy and palliative care. however once disease modifying treatments are no longer available or appropriate, the primary focus will shift to palliative care |
|
|
Term
| what is the reason behind advanced care planning? |
|
Definition
| it is to avoid unwanted emergency hospital admissions so people record their wishes before becoming seriously ill. |
|
|
Term
| define clinical integrity |
|
Definition
| respecting a pts values, needs and wishes, intergration of the best available care and rx with a desire to bring a genuine benefit to the person in a way that is fair to everyone involved |
|
|
Term
| define doctrine of double effect |
|
Definition
| a single act having 2 possible forseen effects, one good and one harmful is not always morally prohibited if the good effect is intended and the means to the good effect is not through the bad effect. there must be no other safer way of achieving the same result |
|
|
Term
| define bereavement and grief |
|
Definition
bereavement: the experience of the death of a loved one
Greif: the response of sorrow or distress following a death |
|
|
Term
| concepts of the Denver grief wheel |
|
Definition
loss
shock
protest; anger guilt
disorganisation; sadness loneliness and emptiness
reorganisation; helps person to return to previous level of functioning often with a changed attitude to life and values |
|
|
Term
| which grief model can help to explain why someone may cope with grief well one day but appear to be coping badly another day? |
|
Definition
the dual process model.
the person griefing oscillates between loss-orientated and restoration-orientated greif |
|
|
Term
| what does MCCD stand for? |
|
Definition
| medical certificate of cause of death |
|
|
Term
breathlessness is associated with palliative COPD.
what symptom is associated with AIDS? |
|
Definition
|
|
Term
| what is the principles for symptom management? eema |
|
Definition
evaluation
explanation
mx
monitoring
attention to detail |
|
|
Term
for cancer related oedema you give corticosteroids
for malignant bone pain: bisphosphonates
what would you give for skeletal muscle spasm and smooth muscle spasm? |
|
Definition
skeletal muscle spasm: baclofen, BDZ
smooth muscle spasm: antimuscarinics, nifedipine, nitrates |
|
|
Term
| non drug treatment and drug rx of reduced salivation? |
|
Definition
non drug: chewing gum
drug rx: pilocarpine |
|
|
Term
| non drug and drug rx for oral thrush |
|
Definition
non drug: good mouth care and wash dentures thoroughly each day
drug rx: nystatin for mild. PO fluconazole for moderate-severe. |
|
|
Term
| non drug and drug rx for oral thrush |
|
Definition
non drug: good mouth care and wash dentures thoroughly each day
drug rx: nystatin for mild. PO fluconazole for moderate-severe. |
|
|
Term
what does hypogeusia mean?
what does aguesia mean? |
|
Definition
hypoguesia: food does not taste the same
reduction in taste
aguesia: loss of taste, everything tastes like cotton wool |
|
|
Term
| what does paraguesia mean? |
|
Definition
| unpleasant taste eg I have a metallic taste in my mouth |
|
|
Term
| which cytokines increased in cancer cause anorexia? |
|
Definition
|
|
Term
| for cance rpt with early satiety what medical management could you give? what non medical management could you give? |
|
Definition
non medical management: small helping looks better on a small plate
medical rx: prokinetics |
|
|
Term
| what medications can be given to stimulate appetite in people with cancer? |
|
Definition
steroids: pred or dexamethasone
progesterones: megestrol acetate |
|
|
Term
| how is cachexia categorised? |
|
Definition
| loss of skeletal muscle +- body fat that cannot be fully reversed by conventional nutritional support |
|
|
Term
| rx for dysphagia when cancer is causing obstruction? |
|
Definition
oesophageal stent
radiotherapy +/- chemotherapy
dexamethasone eg 12-16mg/24h
get a SALT involved |
|
|
Term
| what is the medical rx for dysphagia caused by oesophagitis/oesophageal spasm |
|
Definition
| glyceryl trinitrate 400mcg SL 15min before food |
|
|
Term
| which drug in small doses can be used as an antitussive? |
|
Definition
|
|
Term
| drug to reduce excessive salivation? |
|
Definition
|
|
Term
| what is simeticone used for? |
|
Definition
| excessive belching it is called an antiflatulent |
|
|
Term
| what type of drugs are hyoscine butylbromide, glycopyrronium and octreotide? |
|
Definition
|
|
Term
| for gastric statis, gastritis, functional bowel obstruction which is the prokinetic/anti emetic of choice? |
|
Definition
|
|
Term
| to rx chemical causes of vomiting e.g due to morphine, hypercalcemia, renal failure which medication of choice is used? |
|
Definition
| haloperidol , this is an anti-emetic acting principally in the CTZ |
|
|
Term
bisacoldyl and senna are stimulant laxitives
true or false? |
|
Definition
|
|
Term
| dantron is another stimulant laxative. what is an adverse effect of this on the skin? |
|
Definition
| it can cause contact skin burns in those with urinary or faecal incontinence |
|
|
Term
| what is methylnaltrexone and how is it administered? |
|
Definition
| peripherally acting opioid antagonist given as SC injection for people with opioid induced constipation who are not responding to max dose of laxitives. |
|
|
Term
| loperamide is used in diarhhorea but which anti secretory drug may be added in radiotherapy induced diarhhoea? |
|
Definition
|
|
Term
|
Definition
metoclopramide and venting
if venting is not possible then use anti muscarinincs
in low obstruction: surgical intervention. if this is not possible then use anti secretory (octreotide) anti emetic and anti inflmmatory drugs such as dexamethasone |
|
|
Term
| mx of inoperable bowel obstruction |
|
Definition
Rest bowel by restricting PO intake to sips.
NG tube for pts with lots of vomit
correct low K+ and low Mg2+
dexamethasone
ranitidine: anatacid cover and unlike PPIs it reduces gastric secretions and can be mixed in the syringe driver |
|
|
Term
| what is the effect of low K+ and low Mg2+? |
|
Definition
| they contribute to peristaltic failure |
|
|
Term
| if a pt has no colic but vomiting we give metaclopromide. what if they have colic or metoclopramide is ineffective? |
|
Definition
| hyoscine butylbromide +/- levomepromazine |
|
|
Term
| name a stool softner that does not distend the bowel? |
|
Definition
|
|
Term
| non drug mx and drug mx of ascites |
|
Definition
non drug: paracentesis
drug mx: spironolactone +/- furosemide |
|
|
Term
| which anti secretory drug is known to reduce the rate of formation of malignant ascites. it increases the time between paracentesis |
|
Definition
|
|
Term
| correctable causes of respiratory infection causing breathlessness |
|
Definition
antibacterials
physiotherapy |
|
|
Term
| how to correct COPD causing breathlessness |
|
Definition
bronchodilators
corticosteroids
physiotherapy |
|
|
Term
| mx of pleural effusion causing breathlessness? |
|
Definition
thoracocentesis
drainage and pleurodesis |
|
|
Term
| mx of pericardial effusion causing breathlessness |
|
Definition
pericardiocentesis
pericarotomy/pericardial window |
|
|
Term
| non drug mx of breathlessness |
|
Definition
use an electrical fan: stimulation of nasal and facial nasopharyngeal cold sensitive receptors
breathing control, techniques and positioning are used in conjunction with an electric fan. |
|
|
Term
| drug rx for breathlessness |
|
Definition
bronchodilators
opioids
oxygen
anxyolytics e.g midazolam |
|
|
Term
| define acute and chronic cough? |
|
Definition
acute <3 weeks
chronic > 8 weeks |
|
|
Term
|
Definition
| rapidly adapting myelinated stretch and C-fibre receptors in the airway |
|
|
Term
| non drug rx for a wet cough |
|
Definition
advise how to cough efficiently
physio
steam inhalation |
|
|
Term
|
Definition
nebulized saline
irritant mucolytic: guaifenesin, ipecacuanha
chemical mucolytic: carbocistene |
|
|
Term
|
Definition
simple linctus
codeine linctus
sodium cromoglicate: improves cough in pts with lung cancer |
|
|
Term
| mx of haemoptysis in cancer pts |
|
Definition
radiotherapy
arterial embolization
drug rx: tranexamic acid may reduce volume and duration of mild-moderate haemoptysis |
|
|
Term
you have a pt with pleural effusion you want to rule out pancreatitis, heamothorax, infection and RA
what would you test for? |
|
Definition
pancreatitis: amylase
haemothorax: haematocrit
infection if fluid is non purulent: PH
RA: glucose |
|
|
Term
characteristic pleural fluid appearances and causes
anchovy sauce
bile stained
food particles
milky
putrid smell |
|
Definition
anchovy sauce: ruptured amoebic abscess
bile stained: biliary fistula
contains food particles: perforated oesophagus
milky colour: chylothorax
putrid smell: anaerobic empyema |
|
|
Term
| rx options for malignant pleural effusions |
|
Definition
monitor
pleural aspiration
small bore tube drainage and talc slurry
thoracoscopy and talc poudrage
ambulatory long term indwelling pleural catheter |
|
|
Term
| how to manage pain in pleurodesis with talc slurry? |
|
Definition
| give premedication 10 mins before procedure with systemic opioid and bendodiazapine |
|
|
Term
| non drug rx for transient hiccups |
|
Definition
inhalation of smelling salts
swallow dry bread or crushed ice
rapidly ingest 2 heaps of sugar
cold key dropped inside the back of the person's shirt or blouse
vagal stimulation: cold compress to face, carotid sinus massage, induced fright
respiratory manoeuvres: breath holding, rebreathing from a paper bag, valsalva manoevres |
|
|
Term
| which 2 antipsychotics are licenced for intractable hiccups? |
|
Definition
| haloperidol and cholpromazine |
|
|
Term
| which receptors are found on the detrusor? |
|
Definition
beta receptors
alpha receptors are found on the sphincter |
|
|
Term
|
Definition
prognosis < 2-4 weeks: BDZ
prognosis >2-4 weeks SSRIs +- BDZ
pregabalin for those not responding to antidepressants |
|
|
Term
|
Definition
if prognosis >4weeks give conventional antidepressant
if <4 weeks give psychostimulant such as METHYLPHENIDATE |
|
|
Term
| drug rx for raised ICP in cancer? |
|
Definition
|
|
Term
|
Definition
non drug: exercise, good sleep hygiene, blood transfusion
drugs: antidepressants, steroids if px <2weeks, psychostimulants |
|
|
Term
| what is STEMMER'S sign in lymphoedema? |
|
Definition
| it is the inability to pick up a fold of skin at the base of the second toe. |
|
|
Term
| advice to pts with lymphoedema |
|
Definition
keep it clean and protect form infection
moisturise with emolient
wear a compression bandage
support it when you are sat so it is elevated |
|
|
Term
| what is lymphatic drainage? |
|
Definition
| a specific type of massage. it is associated with deep breathing. |
|
|
Term
drug treatment in lymphoedema?
why might NSAIDs be undesirable? |
|
Definition
we used paracetamol and opioids
NSAIDs undesirable due to connection of NSAIDS, skin infection and necrotising fasciitis
other meds used include dexamethasone and diuretics |
|
|
Term
| grading of pressure sores |
|
Definition
1: non blanching erythema, intact skin
2: partial thickness skin loss: shallow open ulcer with pink red wound bed, may present as a blister
3: full thickness skin loss: subcutaneous fat may be visible but bone, tendon or muscle not exposed
4:full thickness tissue loss with exposed bone, tendon or muscle. |
|
|
Term
|
Definition
chlorphenamine
phenothiazine |
|
|
Term
| itching due to cholestatis mx: |
|
Definition
stenting CBD. if not poss then:-
sertraline 50-100g daily OR
rifampicin 150-600mg OD OR
danazol(steroid) 200mg OD
naltrexone can also help |
|
|
Term
| itching due to uraemia mx: |
|
Definition
UVB phototherapy
doxepin
gabapentin
sertraline
naltrexone |
|
|
Term
| what is the drug interaction between fentanyl and clarithromycin? |
|
Definition
| the metabolism of fentanyl inhibited so it accumulates leading to opioid toxicity |
|
|
Term
|
Definition
radio/chemotherapy if the cancer is sensitive
if not then:-
high dose steroids dexamethasone 16mg OD/ 8mg BD PO/IV and insertion of self expanding metal stent into SVC |
|
|
Term
| mx of cancer related SVCO with severe symptoms? |
|
Definition
o2 to correct hypoxeamia
high dose steroids 16mg OD to reduce extrinsic compression
insertion of self expanding stent |
|
|
Term
|
Definition
corticosteroids
most get radiotherapy
some get chemotherapy if their tumour is chemotherapy sensitive
only a specific criteria are treated with surgery
those who can walk usually get radiotherapy if they don't meet the criteria for surgical decompression (surgery if prognosis >3 months) |
|
|
Term
| headache in someone with paraplegia/tetraplegia should lead to action. why? |
|
Definition
they may have autonomic dysreflexia
vasoconstriction and bradycardia |
|
|
Term
| symptoms signs of autonomic dysreflexia? |
|
Definition
SBP reaching 300mmHg
DBP reaching up to 220mmHg
pounding headache
anxiety
breathlessness
profuse sweating above the level of spinal injury
cold with goose pimples below level of injury |
|
|
Term
| mx of autonomic dysreflexia? |
|
Definition
confirm diagnosis
if spine is stable sit pt up and remove tight clothing
identify noxious stimuli and remove it this could be a blocked catheter.
if symptoms persis give a vasodilator eg GTN
if BP still high give a PD5 inhibitor
if still high admit to hospital for IV vasodilator therapy e.g IV hydralazine |
|
|
Term
| what is autonomic dysreflexia a complication of? |
|
Definition
|
|
Term
| what is the DDX of malignant hypercalceamia? |
|
Definition
| primary hyperparathyroidism |
|
|
Term
|
Definition
IV saline to correct dehydration
bisphosphonates is definitive rx |
|
|
Term
| drugs used for sedation in the imminently dying pt? |
|
Definition
midazolam 2.5 -5mg stat
haloperidol 2.5-10mg
2nd line
Levopromazine 25mg SC or 12.5mg in elderly
3rd line: for specialist use only
propofol
phenobarbital |
|
|
Term
|
Definition
informal statement of wishes and preferances
a formal Advanced Decision to refuse treatment
A Lasting power of Attorney |
|
|
Term
| what does end of life care planning involve? |
|
Definition
pts wishes and goals in the last few weeks, days of life
symptom mx, nutrition, hydration, psychological and social support, coordination of care and individualised end of life care plan |
|
|
Term
| what is a advance decision to refuse treat also known as? |
|
Definition
|
|
Term
| what are the 5 key priorities in the end of life process? |
|
Definition
1. possibility of dying is recognised and clearly communicated
2. sensitive communication takes place between HCP team and dting pt +/- those important to pt
3. dying person and their close ones involved in decisions about rx and care
4. needs of family and dying person actively explored, respected and met as far as possible
5. individual care plan including food and drink, symptom control and psychological, social and spiritual support is agreed and delivered with complassion. |
|
|
Term
| advantages of continuous SC infusions |
|
Definition
round the clock comfort as not troughs or peaks
less need for repeated injections
generally needs to loaded once daily
control multiple symptoms with combo of drugs
saving nurses times |
|
|
Term
| disadvantages of continuous SC infusion |
|
Definition
possible inflammation and pain at infusions site
lack of flexibility if more than one drug is being administered |
|
|
Term
| mx of delirium when near dying? |
|
Definition
| antipsychotic +/- midazolam |
|
|
Term
| which one penetrates CNS? hyoscine hydrobromide or hyoscine butylbromide? |
|
Definition
|
|
Term
a pt has ESRF and death rattle.
why would you not used hyoscine hydrobromide and use butlybromide instead? |
|
Definition
hydrobromide carries increased risk of delirium due to CNS penetrative effects
you can also use glycopyronium but half the normal dose. |
|
|
Term
| typical dose of glycopyronium? |
|
Definition
200mg
dose of hyoscine hydrobromide? 400mcg
dose of hyoscine butyl bromide? 20mg |
|
|
Term
|
Definition
observe for at least 5 mins to confirm cessation of breathing
test pupillary reflexes
confirm absence of carotid pulse
absence of heart sounds |
|
|
Term
| part I on death certificate is? |
|
Definition
cause of death
II is anything contributing to cause of death |
|
|
Term
| when to refer a death to a coroner? |
|
Definition
when cause of death unknown
no doctor attended during the person last illness
when a doctor attended last illness but was not seen by certifying doctor in last 14 days or after death
death was violent, unnatural, due to industrial disease, due to self neglect, operation/recover from anesthetic, suicide, due to abortion or medical mishap |
|
|
Term
| oral morphine to oral oxycodone conversion? |
|
Definition
divide PO morphine dose by 1.5
eg PO morphine 20 PO oxycodone 15 |
|
|
Term
| po morphine to SC morphine? |
|
Definition
divide PO dose by 2
eg. PO dose 60 SC dose 30
this is the same for oral to SC oxycodone |
|
|
Term
| PO morphine to alfentanil SC? |
|
Definition
| divide PO morphine by 30!!! |
|
|
Term
| how long does a fentanyl patch normally last? |
|
Definition
|
|
Term
| care in the last day 7 points |
|
Definition
recognise
communicate
involve
support
plan
document
review |
|
|
Term
| someone has kidney disease and dying what would you use in chemical related nausea and vomiting due to their condition? |
|
Definition
| haloperidol and levopromazine |
|
|
Term
| define Cheyne-stokes breathing? |
|
Definition
| periods of apnoea alternating with a series of increasing and decreasing amplitude. may also occur due to metabolic upset such as cardiac, renal and respiratory failure |
|
|
Term
| around what % of over 80 suffer form falls each year? |
|
Definition
|
|
Term
| signs on biochemistry of alcohol xs? |
|
Definition
raised GGT
raised MCV
mild thrombocytopeania low platelets
hyponatreamia
low urea |
|
|
Term
| which opioid is generally good for those with chronic liver disease in need of opioid pain relief? |
|
Definition
| fentanyl patch. it causes less histamine release and less heamodynamic compromise than other oipiods |
|
|
Term
| what CT scan changes suggest cerebral atrophy? |
|
Definition
| dilation of sulci and ventricles. this is commonly seen in Alzheimers |
|
|
Term
| you get confabulation in korsakoffs and which other type of dementia? |
|
Definition
|
|
Term
| 85 yo end of life care home resident has discomfort from bowel obstruction but isn't suitable for medication. what medication would be suitable to help reduce her distress?? |
|
Definition
| an anticholinergic such as oxybutynin as it would reduce bowel motility especially if used with an opiate |
|
|
Term
|
Definition
due to xs calcium and phosphorus in a diabetic who has chronic renal failure.
it starts out as pink mottled area of skin that ends up as ulcer/eschar |
|
|
