{"id":260,"date":"2017-03-26T12:21:25","date_gmt":"2017-03-26T12:21:25","guid":{"rendered":"http:\/\/papergp.com\/?page_id=260"},"modified":"2023-01-24T11:25:26","modified_gmt":"2023-01-24T11:25:26","slug":"palliative-symptom-management","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/others\/palliative\/palliative-symptom-management\/","title":{"rendered":"Palliative symptom management"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4>Data gathering<\/h4>\n<ul>\n<li>Red flags<\/li>\n<li>Others &#8211; Shx &#8211; family, and support for them, pain, n&amp;v, constipation, PU, breathing, appetite, mood, sleep<\/li>\n<li>Examine &#8211; depends on symptom<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Clinical management<\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>AXR, CXR<\/li>\n<\/ul>\n<\/li>\n<li>Treatment\n<ul>\n<li>Pain\n<ul>\n<li>Paracetamol -&gt; naproxen -&gt; co-codamol -&gt; tramadol -&gt; oramorph\/MST<\/li>\n<li>Strong opioids &#8211; oramorph 5mg 4 hourly \u00a0(increase in 50% increments) &#8211; if &gt;300mg in 24hr dw palliative care &#8211; consider 12 hourly modified release (MST)\n<ul>\n<li>Oramorph &#8211; start at 5mg four hourly for complete pain relief<\/li>\n<li>once control achieved, divided 24hour dose by 2 and give MST 12 hourly<\/li>\n<li>use 1\/6 total daily dose for breakthrough pain<\/li>\n<li>as tolerance occurs, add oramorph and divide total dose again once control achieved<\/li>\n<li>give laxative, anti emetic<\/li>\n<li>patches\/injections if unable to swallow<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Anorexia<\/li>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>causes: mood, drugs, sore mouth, obstruction<\/li>\n<li>lifestyle: small plates and feeds<\/li>\n<li>metoclopramide 10mg TDS, prednisolone 30mg OD<\/li>\n<\/ul>\n<\/li>\n<li>Breathlessness\n<ul>\n<li>causes: pneumonia, effusion, bronchospasm<\/li>\n<li>secretions &#8211; hyoscine hydrobromide 300mcg TDS<\/li>\n<li>bronchospasm &#8211; dexamethasone<\/li>\n<li>others &#8211; o2, nebulised NaCl, bronchodilators, morphine<\/li>\n<\/ul>\n<\/li>\n<li>Constipation\n<ul>\n<li>causes: opioids\/dehydration\/hypercalcaemia<\/li>\n<li>fluids, senna, movicol, glycerol suppository, phosphate \u00a0enema<\/li>\n<\/ul>\n<\/li>\n<li>Bone pain\n<ul>\n<li>opiates, NSAIDs, radiotherapy<\/li>\n<li>Delirium<\/li>\n<li>opioids, drug withdrawal, dehydration, electrolytes.<\/li>\n<li>Haloperidol 0.5mg PO or s\/c.<\/li>\n<li>Nurse in quiet area with minimal noise and good lighting<\/li>\n<\/ul>\n<\/li>\n<li>N&amp;V\n<ul>\n<li>causes: medications, infection, obstruction\/constipation, raised calcium, renal failure, raised icp<\/li>\n<li>bloods: U+Es, calcium<\/li>\n<li>Metoclopramide 10mg TDS<\/li>\n<\/ul>\n<\/li>\n<li>Hiccups\n<ul>\n<li>Metoclopramide, chlorpromazine, gaviscon<\/li>\n<\/ul>\n<\/li>\n<li>Anxiety\n<ul>\n<li>causes<\/li>\n<li>Carers, Macmillan nurses<\/li>\n<li>SSRI, diazepam 2-5mg TDS, temazepam (insomnia)<\/li>\n<\/ul>\n<\/li>\n<li>Haemorrhage\n<ul>\n<li>sedation, consider emergency referral<\/li>\n<\/ul>\n<\/li>\n<li>Hypercalcaemia\n<ul>\n<li>hydration, bisphosphonates<\/li>\n<\/ul>\n<\/li>\n<li>Seizures\n<ul>\n<li>midazolam\/rectal diazepam. consider prophylactic anticonvulsant<\/li>\n<\/ul>\n<\/li>\n<li>Spinal cord compression\n<ul>\n<li>emergency referral<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Safety net &#8211; regular reviews<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Notes<\/h4>\n<ul>\n<li>Services available: Community palliative care teams, district nurses, Macmillan nurses, local hospices, social services, benefits<\/li>\n<li>With symptoms, always consider the cause<\/li>\n<li>Example of syringe driver prescription (for opioid naive patient):\n<ul>\n<li>Medication (subcutaneous) &#8211; dose (in 24hr)\n<ul>\n<li>Morphine sulphate &#8211; 20mg<\/li>\n<li>Midazolam &#8211; 10mg<\/li>\n<li>Haloperidol &#8211; 3mg<\/li>\n<li>Hyoscine butylbromide &#8211; 60mg\n<ul>\n<li>+ PRN for breakthrough &#8211; 1\/10 to 1\/6 of 24 hour dose<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Data gathering Red flags Others &#8211; Shx &#8211; family, and support for them, pain, n&amp;v, constipation, PU, breathing, appetite, mood, sleep Examine &#8211; depends on symptom &nbsp; Clinical management Investigations AXR, CXR Treatment Pain Paracetamol -&gt; naproxen -&gt; co-codamol -&gt; tramadol -&gt; oramorph\/MST Strong opioids &#8211; oramorph 5mg 4 hourly \u00a0(increase in 50% increments) &#8211; &hellip; <a href=\"https:\/\/papergp.com\/index.php\/others\/palliative\/palliative-symptom-management\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Palliative symptom management<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2310,"menu_order":196,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-260","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/260","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=260"}],"version-history":[{"count":5,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/260\/revisions"}],"predecessor-version":[{"id":2041,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/260\/revisions\/2041"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/2310"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=260"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}