Palliative Care

Question 1

WHO definition of palliative care

Answer 1

1. An approach that improves QoL of pts + their families
2. Facing the problems associated with life-threatening illness
3. through the prevention and relief of suffering
4. by means of early identification + impeccable assessment
5. and trx of pain + other problems, physical, psychosocial + spiritual

Question 2

definition of unlicensed medicine

Answer 2

a medicine without a European or UK marketing authorisation for use in humans

and is not licensed to be marketed in the UK

Question 3

definition of off-licence (off-label) medicine

Answer 3

a licensed medicine used for unlicensed applications

e.g. an unlicensed indication, an unlicensed route or at an unlicensed dose

Question 4

complicating factors in palliative care patients

Answer 4

1. concurrent illnesses
2. higher risk of iatrogenic reactions from resultant drug therapy
3. elderly suffer adverse effects from lower doses of drugs
4. adherence issues
5. regular drug review
6. blood levels of digoxin only taken if appropriate to act on result

Question 5

Death Certification

confirmation of death in the case of a cardiopulmonary arrest in a hospital setting where an attempted resuscitation has occurred

Answer 5

• pt observed for signs of life for at least 5min
• no palpable central pulse
• no heart sounds on auscultation
• cardiac monitor displayed at least 5 min of continuous asystole
• absence of pupillary light reflex, corneal reflex and of any response to painful stimuli

Question 6

Death Certification

confirmation of death in the case where the pt had a valid DNACPR (do not attempt cardiopulmonary resuscitation) in hospital:

Answer 6

• absence of pupillary light reflex, corneal reflex and of any response to painful stimuli
• no palpable central pulse
• no heart sounds on auscultation for 2 min
• no chest wall movement and no audible breath sounds for 2 min.

no additional monitoring is required in these patients i.e. no ECG or cardiac moniter

Question 7

opiate of choice for patients with renal impairment

Answer 7

oxycodone

Question 8

what are the four main symptoms common in the last days of life

Answer 8

1. resp secretions
2. N + V
3. pain
4. terminal agitation