Palliative
What is the definition of palliative?
An approach that improves the quality of life of patients facing life-threatening illness through prevention and relief of suffering by treatment of pain and other problems, physical, psychosocial and spiritual.
Which opioids can be used in renal failure?
Mild - Oxycodone
Severe - fentanyl and buprenorphine
What are the four principles of assess capacity?
Understand
Retain
Use
Communicate
What is the investigation needed in a patient with known cancer and persistent back pain?
Full spine MRI in <24 hours
What is End of Life care?
Likely to die within the next 12 months
Which dopamine 2 antagonist antiemetic can be used in Parkinson's?
Domperidone
True or False?
According to the Mental Capacity Act the perspective of any Lasting Power of Attorney has precedence over the written advance decision.
True
What causes positive Pemberton's sign?
Superior vena cava obstruction
What is End of Life strategy?
Comprehensive framework published by the Department of Health and Social Care promoting high quality care across the country for all adults approaching the end of life
What medication can be prescribed to help with significant respiratory secretions?
Hyoscine butylbromide
Glycopyrronium bromide
What is an advanced directive?
Documents written at a time when a person is of sound mind, of that individuals preferences with respect to medical treatment, should they later become unable to express those wishes directly
When is neutropenic sepsis most common after chemotherapy?
7-14 days post chemo when the neutrophils are at their lowest
What are the 2 of the 4 categories of paediatric palliative care (life-limiting conditions)?
1 Life-threatening conditions for which curative treatment may be feasible but can fail – malignancies
2 Conditions where premature death is inevitable, where they may be long periods of intensive treatment aimed to prolonging life – cystic fibrosis
3 Progressive conditions without curative treatment options where treatment is exclusively palliative and may commonly extent over many years – Battens disease
4 Irreversible but non-progress conditions causing severe disability leading to susceptibly health complications and likelihood of premature death – severe brain injury
What anti-emetic is good for treating nausea and vomiting in chemotherapy?
Anti-emetic
Laxative
What should there be in order to confirm patient death?
No spontaneous movement
No respiratory effort
No heart sounds or palpable pulses
No corneal reflex
Pupils fixed and dilated
Unresponsive with body temperature >35
How would you manage neutropenic sepsis?
ABCDE approach
Full septic screen - oxygen, blood cultures, ABs, fluids, lactate, urine output monitoring
Antibiotics - pipercillin-tazobactam IV QDS. If still unwell after 48 hours add meropenem +/- vancomycin
Consider anti-metics, nutritional support, manage mucositis and transfusion
What are 3 of the general indicators of poor or deteriorating health according to the SPICT tool?
Unplanned hospital admission
Performance status is poor or deteriorating with limited reversibility
Depends on others for care due to increasing physical and/or mental health problems
Progressive weight loss, remains underweight or low muscle mass
Persistent symptoms despite optimal treatment of underlying conditions
There person asks for palliative care, chooses to reduce, sop or not have treatment or wishes to focus on quality of life
What can be used for agitation and confusion in palliative care?
Haloperidol
Other - chlorpromazine, levomepromazine
Terminal phase of illness best treated with midazolam
What are lasting power of attorney's?
Appointed by patients under the mental capacity act before they lose their capacity, and can make decisions on their behalf. The LPA cannot make treatment decisions if the patient still has capacity.
What individuals are at higher risk of tumour lysis syndrome and what can be given to reduce the risk?
Increased risk: AML, ALL and lymphomas, first cycle of chemotherapy
Reduce the risk: Allopurinol, Rasburicase