palliative care

Palliative care def

Approach to improve QoL for those involved with life threatening illness

QoL def

Individuals satisfaction with health, social enviroment and ability to interact with environment (physical, social, emotional domain)

How to measure QoL

Observation - behaviour, BCS, appetite, leth, mobility

Questionnaires

Components of palliative care

O expectations

Nutrition

Pain management

Alternative medicine

Tx CS

Nutrition - what to assess

BW, BCS, m condition

Appetite

Nutrition - Diets to give + avoid

Avoid raw food (bact, balance)

Commercial best

Nutrition - Diets to give for CKD, DM, hyperthyroid, OA

CKD = low protein

DM = slow release carbs

Hyperthyroid = high protein, dec carbs

OA = long chain omega 3 PUFA, anti oxidants

Nutrition - Feeding techniques to inc appetite + intake

Slow diet changes

Constistency changes

Small frequent meals

Heat cat meals

Oesophagostomy tubes

Percutaneous endoscopic Gastrostomy tube

Nutrition - Meds to give if V + nausea

Maropitant, ondansetron

Nutrition - Meds to give to inc appetite

Mirtazapine, capromorelin

How to recognise pain

Physical responses - palp, self trauma, vocalise

Altered appetite, tachypnoea, tachycardia, poor coat

Dec activity, posture, ambulation, gait

Attitude change, facial expression (low head, squint), sleep disturbance

Types of pain

Acute/ adaptive

Chronic / maladaptive/path (>3mon)

Options for pain management - acute

Opioid, nsaid, LA, anti NGF monoclonal ab, ketamine, alpha 2 ag

Options for pain management - chronic

Amantadine, gabapentin, steroids, tramadol

NSAID, anti NGF monoclonal ab

Osteosarcoma - causes of pain

Infl

Osteolysis

Osteosarcoma - Pain tx (stop osteoclasts)

Hypofractionated radiotherapy

Bisphosphonate infusions

Osteosarcoma - Bisphosphonate examples

Pamidronate, zoledronate

Alternative medicine exemplars

Acupuncture

Milk thistle

Coriolus versicolour

Cannabinoids

Hwo to treat cancer specific pain

Amputate

Sx excision

Stents in urethra + trachea

Cystotomy tubes

Factors in deciding Euth

Suffering

Disease extent + nature

Tx options

Prognosis

QoL post tx

Tx success

Age

Comorbidities / health status

Cost

Considerations for Euth appointment

Timing

Forms

O expectations - cremation, peri mortem effects