|
Palliative Care 3 is an essential guide for practitioners and carers involved in management of terminally ill patients. An emphasis is placed on the need for a holistic approach to palliative care, and guidance is provided on the treatment of an extensive range of symptoms that may be present. Aspects of emotional and spiritual care are discussed, and the value of a team approach and the role of carers and family members emphasised. Topics in Palliative Care version 3
Principles of palliative care
- What is palliative care?
- Core values
- Dying is normal
- Who should receive palliative care?
- When should palliative care be delivered?
- Diagnosis of a life-threatening illness
- Transition from curative to palliative intent
- Deterioration
- Terminal stage
- Bereavement
- How should palliative care be delivered?
- Setting goals of care
- Palliative care team
- Where should palliative care be provided?
- Home
- Aged care facilities
- Hospitals
- Hospices
Emotional care of the provider of palliative care
- Stress and burnout
- Self-care principles for providers
- Principles for care of staff
- Debriefing
Ethical issues
- Ethical dilemmas in the care of dying patients
- Ethical dilemmas concerning ‘cause of death’
- Ethical dilemmas in communication and decision-making
Communicating with and supporting the patient
- Cultural issues
- Interpreters
- Patients from other cultural backgrounds
- Facing death
- Talking about death and dying
- When and how?
- Breaking bad news
- Dealing with uncertainty
- Promoting communication
- Advance directives
- Dealing with loss
- Psychological symptoms
- Spiritual distress
- Response to spiritual distress
- Unrelieved suffering and spiritual distress
- Social support issues
Loss, grief and bereavement
- Is the grief normal or complicated?
- Those at greater risk of complicated grief
- Development of a preventive management plan
- Normal grief
- Support for normal grief
- Bereavement follow-up
- Complicated grief
- Depression
- Pathological relationships
- Chronic grief
- Special types of loss
- Childhood bereavement
- Bereavement in the very elderly
- Acquired immunodeficiency syndrome
- Traumatic death
- Unexpected death
Community care
- Is community care an option?
- What is available to meet the needs?
- Caregivers
- Volunteers
- Community services
- Hygiene needs
- Medications
- Dietary requirements
- Dressings
- Equipment
- Financial assistance
- Other services
- Communication
- Role of the general practitioner
- On-call and after-hours arrangements
- Expected death in the community
Pertinent practical points
- Frequently asked questions
- Providers
- Patients
- Family and carers
- Duties after patient death
- Practical matters
- Legal obligations
- Care of the family
- Advice for locums
- Issues to consider
- Situations that may be encountered
- Terminal care
- Deceased patient
- Complementary and alternative therapies
- Whole medical systems
- Mind-body medicine
- Biologically based practices
- Manipulative and body-based practices
- Energy medicine
- Cautions with complementary and alternative therapies
Getting to know your drugs
- Analgesics
- Paracetamol
- Nonsteroidal anti-inflammatory drugs
- Opioids
- Opioids not recommended for use in palliative care
- Opioid antagonists
- Co-analgesics
- NMDA-receptor antagonists
- Antiepileptic drugs
- Antidepressant drugs
- Antiarrhythmic drugs
- Clonidine
- Corticosteroids
- Bisphosphonates
- Benzodiazepines
- Skeletal muscle relaxants
- Anticholinergic drugs
- Calcium channel blockers
- Laxatives
- Stool-softening laxatives
- Stimulant laxatives
- Osmotic laxatives
- Bulk-forming laxatives
- Antiemetics
- Metoclopramide
- Domperidone
- Haloperidol
- Prochlorperazine
- Promethazine
- Levomepromazine
- Olanzapine
- Cyclizine
- 5-Hydroxytryptamine type 3–receptor antagonists
- Aprepitant
- Cannabinoids
- Psychostimulants
- Somatostatin analogues
- Drug availability
- Pharmaceutical Benefits Scheme and palliative care
- Off-label use of medicines
- Unregistered (unlicensed) medicines and the Special Access Scheme
Paediatric principles and practice
- Special factors to consider in children and adolescents
- The child and family
- Decision-making
- Issues in symptom management
- Role of health care providers
- Adolescents
- Advanced disease in paediatric palliative care
- Childhood malignancy
- Neurodegenerative disorders
- Cerebral palsy
- Chromosomal abnormalities and congenital malformations
- Concepts of death in childhood
- Communicating with dying children
- Loss, grief and bereavement in childhood
- Preschoolers
- School-age children
- Adolescents
- Support for bereaved children
- Children at greater risk of complicated grief and depression
- Siblings
- Pain assessment
- Paediatric resources
- Websites for professionals
- Bereavement services
- Books
- National organisations
- State organisations
- Drug dosing in children
Principles of symptom control
- Evaluation
- Explanation
- Discussion
- Individualised treatment
- Attention to detail
- Monitoring of progress
- Rapid dose escalation
Emergencies
- Presentation to the emergency department
- Spinal cord compression
- Superior vena cava obstruction
- Acute airways obstruction
- Haemorrhage
- Sudden severe haemorrhage
- Seizures
- Cardiac tamponade from malignant pericardial effusion
Intercurrent illnesses
- Psychological impact of change in long-term medications
- Specific co-morbidities
- Diabetes
- Endocrine conditions other than diabetes
- Hypertension
- Hypercholesterolaemia
- Anticoagulants
Pain
- Types of pain
- Nociceptive pain
- Neuropathic pain
- Breakthrough and incident pain
- Pathophysiology of pain
- Afferent pathways and neurotransmitters
- Sensitisation
- Pain assessment
- History
- Physical examination
- Investigations
- Documentation
- When the patient cannot give a pain history
- Principles of management
- Setting treatment goals
- Setting a treatment plan
- Pharmacological treatment
- Opioids
- Drugs for neuropathic pain
- Pain associated with tumour-related oedema
- Pain associated with skeletal muscle spasm
- Pain associated with smooth muscle spasm
- Bone metastases
- Management of incident pain
- Other treatments
- Radiotherapy
- Antineoplastic agents
- Physical therapies
- Psychological support and treatment
- For the patient still in pain
- Managing pain in patients with substance use disorders
Fatigue
- Nonpharmacological treatment
- Pharmacological treatment
Gastrointestinal symptoms
- Oral symptoms
- Dry mouth (xerostomia)
- Stomatitis and mucositis
- Management of oral symptoms
- Swallowing difficulties
- Anorexia, weight loss and cachexia
- Nausea and vomiting
- General management
- Specific management
- Refractory nausea
- Constipation
- Prophylaxis
- Treatment of established constipation
- Bowel management in patients with paraplegia
- Bowel obstruction
- Types of bowel obstruction
- Management of bowel obstruction
- Stomal constipation and obstruction of stomas
- Diarrhoea
- Malignant ascites
Respiratory symptoms
- Dyspnoea
- Assessment
- Symptomatic relief of dyspnoea
- Management of the underlying cause of dyspnoea
- Cough
- Noisy breathing and secretions
- Haemoptysis
- Hiccups
- Abnormal patterns of breathing
- Slow, shallow and intermittent respiration
- Cheyne-Stokes respiration
- Tachypnoea and hyperpnoea (Kussmaul’s breathing)
Neurological and neuromuscular symptoms
- Headache
- Raised intracranial pressure
- Leptomeningeal disease
- Motor dysfunction
- Malignant plexopathies
- Sensory dysfunction
- Smell and taste
- Vision
- Hearing
- Peripheral sensory loss
- Vertigo, giddiness, faintness and dizziness
- Spinal cord compression
- Urinary retention and incontinence
- Seizures
- Continuing management of seizures
- Movement disorders and restlessness
- Ataxia and incoordination
- Myopathies and myasthenias
- Multifocal myoclonus
- Cramps and spasms
- Delirium, dementia and other disorders of brain function
- Cerebral metastases
Psychiatric symptoms
- Mood disturbances
- Depression
- Anxiety and associated disorders
- Suicide
- Sleep disturbance
- Drug and alcohol problems
Dermatological symptoms
- Sweating
- Pruritus
- Nonpharmacological management
- Pharmacological management
- Rash
- Herpes zoster
- Candidiasis
- Treatment reactions
- Lymphoedema
- Skin manifestations of cancer
- Pressure sores
Haematological problems
- Anaemia
- Neutropenia
- Bleeding disorders
- Thrombocytopenia
- Disseminated intravascular coagulopathy
- Venous thromboembolism (VTE)
- Persistent bleeding
Genitourinary symptoms
- Urinary incontinence
- Stress incontinence
- Urge incontinence
- Overflow incontinence
- Continuous incontinence
- Functional incontinence
- Urinary frequency
- Urinary retention
- Haematuria
- Bladder pain
- Catheterisation
- Obstructive uropathies
- Vaginal symptoms
Paraneoplastic syndromes
- Hypercalcaemia of malignancy
- Syndrome of inappropriate secretion of antidiuretic hormone
- Cachexia--anorexia syndrome
- Other paraneoplastic endocrine/metabolic syndromes
Life-limiting illnesses other than cancer
- Burden of disease
- Course of disease and goals of care
- Know the person who is being treated
- Know the disease that is being treated
- Where choices exist about therapy
- Key clinical issues for specific end-stage organ failure
- Heart failure
- Respiratory failure
- Hepatic failure
- Renal failure
- Neurodegenerative disorders
HIV/AIDS in palliative care patients
- Issues for all palliative care patients with HIV/AIDS
- Social stigmatisation
- HIV-related chronic pain syndromes
- The ongoing role of highly active antiretroviral therapy (HAART)
- Other medication-related issues
- Issues for patients with end-stage AIDS
- Symptoms pertinent to end-stage AIDS
- Identifying the terminal stage
Terminal care
- Communication
- Site of care
- Resuscitation
- Nutrition and fluids
- Cessation of oral medications
- Adequacy of analgesia
- Management of distress and unrelieved symptoms
- Noisy breathing
- Continuing care
- Duties after patient death
Drug administration
- Routes of administration
- Enteral administration
- Subcutaneous administration
- Intrathecal and epidural administration
- Nasal administration
- Topical administration
- Nebuliser
- Infusion devices
- Compatibilities of drugs in syringes
- Resources
- Enteral feeding
- Syringe drivers
- Compatibility of drugs in syringes
- Other routes of administration
Patient assessment tools
Resources
Electronic version
Therapeutic Guidelines: Palliative Care is available in electronic format as part of eTG complete.
|
Hear Professor Peter Ravenscroft