Managing other symptoms

Question 1

What are some causes of a cough in a palliative patient?

Answer 1

Infection
Cancer or mets in lungs
GORD
Asthma
Drug-induced cough

Question 2

How can a cough be managed in a palliative patient?

Answer 2

Assess appropriateness of antibiotics if infective cause

3 different types of drugs

1. Cough suppressants:
   - codeine
   - morphine
   - methadone
2. Expectorants (encourage more productive cough)
   - Sodium chloride nebs
3. Demulcents: soothing, protective film on mucus membrane
   - Glycerol syrup

Question 3

What 3 remedies are there to treat a cough in a palliative patient? How do they help and give examples?

Answer 3

Cough suppressants:
Suppress cough
- codeine
- morphine
- methadone

Expectorants:

• make cough more productive
• NaCl nebulisers followed by physio

Demulcents: soothes and protects mucus membrane
Glycerol syrup

Question 4

What are some causes of SOB in palliative patients?

And how can we manage each type?

Answer 4

Airway obstruction (COPD, asthma)

• bronchodilators (salbutamol)
• INH or PO corticosteroids
• anti-cholinergics (ipatropium)

Malignancy
- Respiratory sedatives (morphine)

Heart failure

• Diuretics
• ACEi
• Digoxin
• Respiratory sedatives (morphine)

SVC

• Corticosteroids
• Chemo + radiotherapy

Anxiety
- benzodiazepines

Question 5

Briefly describe what SVC obstruction is?

Answer 5

When a tumour presses on the SVC meaning blood builds up in the veins in the head

There’s SOB, dysphagia, stridor

Question 6

You can treat SOB using respiratory sedatives. What are these and how do they work?

Answer 6

Opioids

Not fully understood how it works
Opioids reduce ventilatory response to hypercapnia, hypoxia and increased HR

This reduces respiratory effort and thus reduces dyspnoea

Question 7

How do benzodiazepines help in SOB?

Answer 7

Reduces the perception of breathlessness and reduces anxiety which could be raising resp rate

Question 8

Why do palliative patients get bleeding problems?

Answer 8

Thrombocytopenia
Vit K deficiency
Heparin-induced thrombocytopenia
Hepatic or renal impairment
Tumour eroding intp blood vessel
Lung cancer causing haemoptysis

Question 9

If you have a palliative patient with moderate bleeding problems, what should you do?

Answer 9

Correct correctable

Stop blood thinners: aspirin, heparin, warfarin

Treat with:

• transexamic acid
• radiotherapy if it is haemoptysis
• treat any bleeding wounds

Question 10

How would you treat a palliative patient with major bleeding?

Why might a major bleed occur?

Answer 10

In many cases, no treatment is necessary if this happens. Just make them comfortable and get family nearby. Death often occurs within minutes.

If the tumour erodes a blood vessel