Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

47 Cards in this Set

  • Front
  • Back
What is palliative care?
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.
The transition from curative to palliative medicine will be influenced by many factors, including what?
- The strength of the patient's desire to pursue cure.
- Cultural views on illness, dying and the roles of men and women.
- The patient's age.
- Family responsibilities.
- Work and social commitments and plans.
What are the core tasks of palliative care?
- Competent pain and symptom relief.
- Management of the psychological, spiritual and temporal aspects of the person and the close carers.
- Awareness and management of the distress of those caring for the dying person.
- Awareness that care of the carers continues after the patient's death; bereavement is a part of the process.
Describe the concept of 'total pain'.
- Total pain is the totality of suffering comprised of physical, psychological, and spiritual distress.
- One element cannot be seen in isolation.
- Each element affects the others.
What is the principle of double effect? Why is it not considered a form of euthanasia?
Some treatments that aim to alleviate pain and suffering have the potential to shorten life. E.g. rapidly increased opioids can cause respiratory depression.

It is not euthanasia because of the INTENT of treatment is important - the intent of the double effect is to ALLEVIATE symptoms. Death MAY occur as a result of this, but was not the original intent.
The palliative care team is a multidisciplinary team. Who can be members of this team?
- GPs.
- Palliative care doctors.
- Nursing (palliative care, community, domiciliary, patient education, stomatherapy).
- Family & friends.
- Community health workers (social workers, case managers).
- Therapy services (occupational, physio, speech, music).
- Pain service.
- Psychiatry.
- Oncologists.
- Chaplaincy.
- Pharmacist.
- Volunteer services.
- Radiotherapy technician.
- Support groups.
- Alternative medicine practitioners.
What is the GP's role in palliative care?
- Competent pain and symptom relief.
- Case coordination.
- Support for carers.
- Legal requirements at death.
- Bereavement followup of surviving carers.
What are the principles of clinical palliative care?
- Utilise knowledge of pathology of symptom.
- Assess cause of symptom.
- Develop an appropriate management plan.
What is the definition of pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is always subjective.
What is the definition of suffering?
Pain + physical symptoms + psychological problems + social difficulties + cultural factors + spiritual concerns.
Describe the WHO analgesic step ladder.
Step 1: Non-opioid +/- adjuvant.

Step 2: Mild/moderate opioid +/- non-opioid +/- adjuvant.

Step 3: Opioid for moderate to severe pain +/- non-opioid +/- adjuvant.
What are the limitations of the WHO analgesic ladder approach?
- Only relates to pain intensity and does not identify causes and types of pain.
- Step 2 is often omitted.
- Adjuvants have increasing usefulness, but are portrayed in the ladder as second-line treatments.
- No consideration of alternate routes of administration.
What is the principle behind the mechanistic approach to cancer pain?
- Type of pain dictates analgesic choice.
- Encourages assessment of cause of pain.

Describes types of medications used for different types of pain:
- Nociceptive-type: superficial somatic, deep somatic, visceral.
- Non-nociceptive type: Neurogenic or non-neurogenic.
What are the features of nociceptive somatic pain?
- Constant.
- Localised.
- Worse on movement.
What are the features of visceral pain (capsule stretch AND colicky)?
Capsule stretch:
- Constant.
- Dull.
- Poorly localised.
- Associated with a solid organ.

- Associated with hollow organ.
According to the mechanistic approach, what nociceptive pain therapies are available?
- Analgesic drug therapy-Paracetamol, Adjuvants(steroids, anticonvulsants, anti-depressants, benzodiazepines, neuroleptics, ketamine).
- NSAID’s: for bone pain, inflammatory pain.
- Opioids.
- Bisphosphonates.
- Palliative anti-cancer treatments: chemotherapy, hormonal therapy, radiotherapy, surgery.
- Specialist pain procedures: Opioid infusions, Spinal nerve blocks, Autonomic nerve blocks.
- Neurosurgical procedures e.g. percutaneous cervical cordotomy.
What is the underlying pathological processes of neuropathic pain?
- Disruption of normal neurone function leading to hyperactivity at some level of sensory system.
- Damage to nerve fibres caused by compression or invasion of tumour.
- Plasticity, hyperexcitability, wind-up.
- NMDA receptor importance.
- central sensitisation.
What are the clinical features of neuropathic pain?
- Often opioid resistant.
- Burning, constricting, constant, sometimes sharp lancinating.
- Refers to dermatomesand may be associated with allodynia (brought on by simple touch).
According to the mechanistic approach, what are the treatments available for neuropathic pain?
- Opioids (not effective).
- Adjuvants (antidepressants, antiepileptics like carbamazepine and gabapentin, anti-arrhythmics).
What forms of morphine are available?
- Liquid ( “Ordine”, “Mist Morphine”) or tablets (“Sevredol”) oral, short-acting, 20 minute onset action, 4 hour duration.

- Long acting oral forms(MS Contin, Kapanol).

- Slow release with peak levels after 12 hours, and 12-24 hrs duration Injectable subcutaneous -morphine sulphate, Morphine tartrate.
How does one initiate morphine treatment?
- Try and begin with liquid oral form - begin at small doses with full explanation to patient of dose, onset, duration, side effects.

- Trial regimen -eg2.5 mlsof 2mg/ml (ie5 mg) taken 4 hrlyduring day = 4x 5 mg = 20 mg per day. Record daily intake.

- Review doses within 3 days for efficacy and side effects.

- Once stable dosage achieved with effective pain control -change to long -acting oral form and calculate total daily dosage from dose of Ordine given each day.

- Breakthoughor Rescue dose for pain = 1/6th or 1/12 of total daily dose and may be repeated within 2 hours.

- Review regularly to assess breakthrough dosages and total daily dose adjustments.
What is the definition of dyspnoea?
- Undue awareness of breathing.
- Uncomfortable urge to breathe.
- Distressing sensation of difficult laboured breathing.
What is recent dyspnoea in a palliative patient often a clue to?
Imminent death.
Up to 70% of ______ have dyspnoea as a symptom.
Up to 70% of malignancies have dyspnoea as a symptom.
What is the physiology underlying dyspnoea?
- Respiratory muscles activated by nerve impuses from carotid bodies, medullary respiratory centre and chest wall stretch receptors.
- Dyspnoea caused by excess muscle action, weak muscles, stiff lungs.
- “Corollary discharge” (motor/sensory).
What are the common causes of dyspnoea?
- Cancer of the lungs/pleura.
- Effusions/ascites/hepato-splenomegaly.
- Lung disease (COAD, asthma).
- Heart disease (HF).
- Anaemia.
- Mixture.
- 24% no obvious cause. Psychological issues may be important.
What are some non-pharmacological methods to alleviating dyspnoea?
- Posture.
- Reassurance.
- Pursed lips.
- Ventilation.
- Fan on face.
- Oxygen (especially if hypoxic).
What drugs are of proven benefit against dyspnoea?
Oral opioids:
- No adverse effects on PO2/PCO2.
- Alters perception, decreases respiratory drive, reduces oxygen consumption.
- Doses small initially, may need higher if on opioids for pain.

Other medications that may be used:
- Bronchodilators.
- Phenothiazines.
- Steroids.
- Benozodiazepines: help anxiety. E.g. fear of choking, panic, terminal phase.
- Use midazolam subcutaneously, flunitrazepam subcutaneously, lorazopam, others also of use.
What needs to be done for terminal ratty respirations?
- Increased tracheal or bonchial secretions (occasionally pulmonary oedema).
- Treat with anti-cholinergics subcutaneously e.g. hyoscine 0.4mg 1/2 hourly prn.
- Explanation to relatives important.
- Positional changes help.
What are the 'brain' causes of nausea and vomiting?
Stimulation of the chemoreceptor trigger zone vomiting centre by the one of the following:
- Raised intracrnial pressure.
- Palliative care drugs.
- Drugs for normal medical reasons.
- Cranial Nerve VIII stimulation.
- Chemotherapy.
- Metabolic toxins (uraemic, hepatic failure, infection).
What are the GIT causes of nausea and vomiting?
- Thrush.
- Herpes.
- Infected sputum.
- Motility problem.
- Compression.
- Reflux.
- Stricture.

- Ulcers, gastritis.
- Squashed stomach.
- Poor motility.
- Obstruction.

Lower bowel:
- Bowel obstruction.
- Constipation.
What are proven non-pharmacological treatments for palliative nausea and vomiting?
- Pyschological support.
- Small frequent meals.
What drugs can be used to treat chemoreceptor trigger zone (brain) causes of nausea and vomiting?
- Prochloperazine.
- Haloperidol.
- Metoclopramide.
- Ondansetron.
What drugs can be used to treat gut causes of nausea and vomiting?
- Metoclopramide.
- Cisapride.
- Domperidone.
What side effect needs to be considered when prescribing opioids and how do you deal with it?
Constipation - always start a stimulant laxative when starting opioid.
What are the main causes of constipation in sick patients?
- Weak abdominal muscles and pelvic muscles.
- Reduced peristalsis.
- Low fibre intake.
- Dehydration.
Constipation in itself can cause further complications. They include what?
- Partial gut obstruction.
- Diarrhoea.
- Nausea, vomiting, anorexia.
- Restlessness, confusion.
- Rectal pain.
- Urinary retention.
What can be done to prevent constipation?
- Try to maintain a diet with adequate fibre.
- Encourage fluid intake.
- Encourage mobility.
- Offer as much privacy and physically easy settings for defaecation as possible.
What drugs might cause constipation?
- Opioids.
- Tricyclics.
- Anticholinergics.
What laxatives could be used for palliative constipation?
?Bulking agents

Softeners - increase fluid secretion by the bowel wall and soften the stool. E.g. docusate, movicol, lactulose, bisacodyl..

Lubricants - allow easier passage of the bowel motion. E.g. paraffin oil alone or with phenolphthalein.

Stimulants - Simulates peristalsis by irritating the bowel wall. E.g. Senna, phenolphthalein, bisacodyl.

Shaw's Cocktail - useful for stubborn constipation.
With a small amount of hot water, melt one tablespoon of Senokotgranules. A microwave oven can be used to hasten process. Add 20ml Agarol and make up to 100ml with cold milk or ice-cream.
Symptoms of a gut obstruction depends on the site of obstruction.

A gut obstruction that is high up causes more....
- Vomiting.
Symptoms of a gut obstruction depends on the site of obstruction.

A gut obstruction that is low down causes more....
- Distension.
- Pain.
- Reduced bowel movements.
- Reduced or absent flatulence.
What needs to be determined with gut obstruction?
- Partial or complete?
- What is the cause?
- Site of obstruction?
- What is the patient's general state?
- Is surgery warranted?
What is a 'good death'?
- Good pain and symptom management.
- Clear decision making.
- A sense of completion of life tasks.
- Contributing to others.
- Affirmation by the care of the whole person.
What are the risk factors for abnormal grief?
- Male.
- PH mental illness.
- Brief marriage.
- Sudden death.
- Death of child.
- Multiple losses.
- Stigmatised death.
- Poor social support, relationships.
- Economic difficulties.
Whare the potential adverse consequences of bereavement?
- Greater risk of death in first year of loss.
- Increased anxiety, alcohol or tranquilizer use.
- Clinical depression.
- Increased suicide risk.
What are the types of abnormal grief?
- Absent grief: emotional blocking - chronically emotionally flat.
- Delayed: Comes out eventually with a trigger - often in self-controlled people.
- Chronic: normal grieving emotions but prolonged period - often in very dependent relationships.