palliative care

what is the terminal phase

last days of life

what is end of life care

care for the last 12 months of someones life

can palliative care and hospice care be used interchangeably

what is specialist palliative care

approximately ___% of australians say they want to die at home

70

what is the purpose of advanced care planning

appointing subsitute decision maker, document wishes formally

what are some advantages of advanced care planning

helps ensure the patient recieves the care they want, improves ongoing and end of life care with personal and family satisfaction, reduces unnecessary transfers to acute care/unwanted care

________ ________ is often missed

hypoactive delirium

what type of dellirium occurs in the last days of life

terminal restlessness

what is an integrated approach

multidimensional assessment and management

what is a targeted approach

directed at specific causal mechanisms and factors contributing to the problem

what is a tailored approach

suitable for individual circumstances, beliefs and preferences

what 5 aspects are considered to be in relation with total pain

social, cultural, psychological, spiritual, physical

when initiating opioids for pain management what are some factors to have in mind

start low go slow, start with IR short acting opioids, give on a regular basis NOT prn

what are some examples of S/C opioids

morphine, hydromorphone

what are some examples of transdermal opioids

bupe, fentanyl

what are some examples of sublingual opioids

bupe tab, fent tab, fent lozenge

what are some common causes of nausea and vomiting in last year of life

medications, intestinal obstruction,biochemical abnormalities, gastric stasis, increased ICP

which medications can affect the vomiting centre

promethazine, cyclizine, hyoscine

which medications affect the cortical region

dexamethasone, benzos

which medications affect the CTZ

metoclopramide, haloperidol, prochlorperazine

which medications affect the vestibular region

promethazine, prochlorperazine, cyclizine

which medications have effect on GI

metoclopramide, hyoscine, ondansetron

what is the most common anti-emetic in palliative care

metoclopramide

which laxatives do we avoid in palliative care

osmotic and fibre because of reduced fluid intake

what are some medications used for constipation in palliative care

docusate and senna, bisacodyl, macrogol (isosmotic ONLY eg. electrolyte balanced) sachets, methylnaltrexone (opioid induced constipation) injection

what are some advantages of subcutaneous infusion

less infection risk than IV, reliable absorption, increased patient comfort, can be used easily at home

what are some anti-emetics that can be used S/C

metoclopramide, haloperidol

what are some sedatives that can be used S/C

midazolam, clonazepam

what are some anti-secretory agents that can be used S/C

hyoscine butylbromide, glycopyrrolate