functions of palliative care 7
- provide relief from pain and other distressing symptoms
- affirms life and regards dying as natural process
- integrates psychological and spiritual aspects of pt care
- offers a support system to help patients live as actively as possible until death
- offers a support system to help the family cope during the patients illness and in their own bereavement
- enhances quality of life and may also positively influence the course of illness
- come up with end of life strategy (advanced care planning)
does palliative care hasten or postpone death?
neither
when in the disease process is palliative care applicable
early in the course of illness in conjunction with other therapies that are intended to prolong life eg chemo/ radiotherapy, including investigations needed to better understand and manage distressing clinical complications
can also build relationship with pt and have advanced care planning
how many people die annually in the uk
50 000
% of where people die in the uk
58% hospital
18% at home
17% care home
4% hospices (due to low availability)
7 most common illnesses needing palliative care
- cancer (75%)
- chronic lung disease
- chronic liver disease
- end-stage kidney disease
- advanced neurological disorder esp MN
- dementia
- fraility (old age)
define generalist palliative care
- provided for those affected by life-limiting illness as part of standard clinical pratice by ANY HEALTHCARE PROFESSIONAL providing usual practice
- provided in the community by general practice teams, allied health teams, district nurses, residential care staff, community support services, community paediatric teams
- provided in hospital by general adult/ paediatric medical and surgical teams plus disease specific teams (oncology, respiratory etc)
define specialist palliative care
- palliative care provided by those who have undergone SPECIFIC TRAINING OR ACCREDITATION in palliative care or medicine working in the context of a multidisciplinary team of palliative care health professionals
- builds on general palliative care with higher level of expertise in complex symptom management, psychosocial, cultural and grief and loss support
2 ways palliative care division works
- provides direct care to pts with life limiting illness
- advising other carers eg general palliative care as to when to refer
common symptoms of pts with incurable cancer
- fatigue
- pain
- weakness
- loss of appetite
explain oral changes in pts with incurable cancer 5
- dry mouth
- taste changes
- sore mouth
- dysphagia
- hoarseness
these symptoms make pts not want to eat –> weight loss and giving up on life- food is one of the few sources of pleasure to a lot of people
orally related symptoms with incurable head and neck cancer 4
- voice changes, eg due to tracheostomy
- difficulty speaking
- head and neck oedema
- dysphagia
5 role of dentist in cancer pts
- diagnosis of early suspicious lesions
- prophylaxis (checks pre-radiotherapy, pre-chemotherapy, pre-bone marrow transplant to prevent infections with decreased immunity during tx)
- advice re caries/ periodontal disease during tx (increased risk due to immunosuppressant)
- diagnosis of complications of complications of tx
- advice re oral care
3 causes of xerostomia in cancer pts
- tumour (of salivary glands)
- radiotherapy (less saliva, salive more viscous)
- drugs 4 (opioids, anticholinergics, antipsychotics, anxiolytics)
6 problems of xerostomia
- inc ris of caries
- dry mouth is more acidic –> bacteria grow –> caries
- dry, cracked lips
- angular cheilitis (also due to anaemia)
- problems wearing dentures
- difficulty eating, swallowing, communication
treatment of xerostomia 8
- treat underlying cause where poss (eg change meds)
- good oral care
- frequent sips of water (best)
- ice chips
- pineapple (sialogogue, inc saliva flow rate)
- effervescent vitamin c
- saliva substitutes
- chewing gum (2nd best)
2 factors inc oral thrush in cancer pts
- dry mouth
- low immunity
3 roles of dentist in oral thrush in cancer pts
- diagnosis
- advice on management, esp with azole resistance
- advice on denture care (treat dentures too or they re-infect pt)
4 ways to manage sore mouth
- treat underlying cause if poss
- good oral care
- bland foods
- local measures
6 local measures used to treat sore mouth
- gelclair (mechanical barrier)
- difflam spray (LA. bad, causes stinging)
- MuGard oral rinse (mucoadhesive, becomes barrier to mucosa)
- bonjela
- soluble aspirin (local antiinflammatory)
- oramorph (topical analgesic)
2 ways to treat oral pain
- local measures as for sore mouth
- analgesics as per WHO pain/ analgesic ladder
what is the WHO pain/analgesic ladder
1= non-opioid + adjuvant: aspirin/ paracetamol/ NSAID 2= mild- moderate opioid (+non-opioid, adjuvant): codeine 3= strong opioid (+1 and 2): morphine, oxycodone, fentanyl
with what illnesses is drooling common (6 examples)
neurological conditions:
- MN
- head and neck cancer
- Parkinson’s
- brain tumours
- cerebral palsy
- stroke
2 causes of drooling
- overproduction of saliva
- inability to swallow normal amounts of saliva
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Clinical Governance24
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Principles of Operative Surgery27
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Deep Vein Thrombosis and Pulmonary Embolus60
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Vascular history and examination23
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Principles of cancer management32
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Arthritis, Rheumatology36
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Dentistry and mental illness 119
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Medicine in the Elderly*18
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Bleeding, leukaemia and dentistry43
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Dentistry and mental illness 226
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ATLS14
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Head and neck skin cancer32
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Principles of assessment15
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Post op complications20
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Renal Failure45
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Immunocompromised pt42
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Valvular heart disease40
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Gastroenterology65
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Diabetes and its treatment48
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Palliative care31
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Blood Coagulation and Bleeding Disorders37
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Medical Emergencies 123
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Meningitis30
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respiratory tract infections19
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emergencies and collapse8
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control of infection in hospital14
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neurological weakness21
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Endocrine8
