Palliative care and pain management

Question 1

what are some causes of delirium in patients with cancer?

Answer 1

electrolyte derangement: hypercalcemia, hyponatremia, ketoacidosis, dehydration 
cerebral metastases 
medication changes 
major organ failure 
septicemia

Question 2

what are the management principles of delirium?

Answer 2

identify and reverse underlying causes
implement non pharmacological management
implement pharmacological management
implement prevention methods: fall risk asssessment, pressure sores check, prevent over sedation of the patient

Question 3

what is the pharmaceutical management of delirium

Answer 3

first line: haloeperidol (1-2 mg PO. IM, IV). and keep uptritating to effect. non sedating to maximum of 10mg
if agitation cannot be controlled, use benzodiazepines (lorzepam, midazolam) for short term.

Question 4

what is the non pharmaceutical managemnet of delirium

Answer 4

provide a comfortable setting by:
familiar people
soft soothing music
appropriate lighting
aid senses (give hearing aid, vision aid)
peaceful familiar environment
explanation, reassurance, regular orientations

Question 5

what are the reversible causes of delirium

Answer 5

(I WATCH DEATH)

infections (uti, encephalitis, meningitis)
withdrawals from drugs/ETOH
acute metabolic disorder
toxins/drugs (ETOH, BDZ, opiate, anticholinergics, steroids, NSAIDs, dopamine agonist)
CNS pathology - stroke, tumor, seizure
hypoxia - anemia, heart failure, PE

deficiencies 
endocrinopathy 
acute vascular conidtion 
truama
heavy metal posioning

Question 6

outline the analgesia hierachy

Answer 6

parectamol 
NSAIDS 
combination oral therapy (parectamol/codeine) 
opioid 
parental opioid

Question 7

describe the symptoms of somatic pain

Answer 7

localized sting or burning dull ache, can be associated w/ pain on movement

Question 8

describe the symptoms of visceral pain

Answer 8

diffused, deep pain
poorly localized
hollow = spasm/colic
associated w/ nausea vomiting

Question 9

what are the symptoms of muscle spasm

Answer 9

pain that is worse on movement

severe colicky pain

Question 10

what are symptoms of peripheral never pain

Answer 10

pain in nerve distribution assoc. w/ motor and/or sensory deficits

Question 11

what is the management plan for nociceptive (somatic/visceral) pain?

Answer 11

analgesics hierachy:

Question 12

what is hte management of neurogenic pain?

Answer 12

antidepressants, anti-epileptics, membrane stabilizers

Question 13

what is the management of muscle spasm?

Answer 13

baclofen, muscle relaxants