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End stage life care management and palliative sedation

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Video from shahana wahid

Assalamualaikum my name is sarah zaman my roll number is bp1650200 the topic that i have been assigned is end of life care chapter number six and the topic that i have chosen from it is aggressive symptom management and palliative sedation palliative sedation is the use of the medication to induce sedation to relieve the pain sedation is the absence of awareness

These terminally ill patients face aggressive symptoms due to the disease and therapy related adverse effects which can be relieved by palliative sedation in treating the aggressive pains and symptoms we first assess and diagnose the pain like if it’s a physical pain it’s a dyspnea or severe nausea vomiting palliative sedation is used in the last resort and it’s

Not included in general care gastric cancer also known as stomach cancer it develops from the lining of the stomach it has different types and subtypes with varying degree of severity the early symptoms are heartburn upper abdominal pain loss of appetite later on more distinguishable characteristics appear like weight loss bloody vomiting and stools most common

Cause is h pylori also smoking genetic and hereditary diagnosis is done on the basis of biopsy and endoscopy end of life care case cancer patients are generally end staged terminally ill can’t be treated only the symptoms that they are facing could be managed to provide as much ease as possible to the patient so the case study is deviate 35 year old male with

Gastric cancer metastasized with esophagus with periodic involvement is hospitalized he was diagnosed ten months ago disease progressed despite multiple chemotherapies his most recent ones were adenotican and herbitax double human peripherally inserted central catheter line has been inserted he lost 65 lbs since his diagnosis now he weighs 150 lbs at six foot

Tall presents abdominal pain severe nausea vomiting constipation and a general feeling of malaise devi describes pain as 7 upon 10 burning as knife through my stomach he uses a 50 to 75 pca bolus doses every 24 hours he has no other medical problems he is referred to her spice care because he and his wife decided to stop all the chemos he states allergy to

Morphine on dancing and diphenhydramine all those these allergies are not noted he is presently receiving hydromorphone iv infusion um 2mg per hour with 1mg pc bolus dose queue 5 minutes hydromorphone 4mg per oral q4hprn for pain fentanyl transthermal 275 mcg per rq3 days ketamine 20 mg poq3r senna 2 tablets per olb id docusate sodium 250 mg pob id miralex 17

Gram podly lecture lost 15 ml p o prn for constipation lorazepam 2mg per oral q4r prn for nausea and vomiting metoclopramide 10mg q6r prn nausea vomiting for nausea vomiting decloffin 10 mg q8r for hiccups and protonix for tmg once daily what is your assessment for his medication regimen we’ll be seeing that uh so the subject has a chief complaint of abdominal

Pain severe nausea a feeling of malaise vomiting and constipation the current medication that he has been taking are these uh here the pcs stands for um an analgesia patient control analgesia and these are also the medications his age is 35 year he is a male he has a weight of 150 lbs uh his height is 6 foot no ongoing chemotherapy at the hospital as he has

Stopped all uh gastric cancer is metastasized to his esophagus now the assessment is patient has end stage gastric cancer metastasized to its esophagus with severe abdominal pain constipation weight loss around 65 lb since his diagnosis patient is a palliative care patient now treating the severity of his symptoms has terminal illness with a general feeling of

My life we assess that this patient drug regimen is unnecessarily complicated however it is still not helping to keep the pain in control so multiple drugs are being used here for the same purpose which is not helping and also decreasing the patient compliance the more the drug the less the patient compliance is pca which is analgesia should be given either iv

Or oral if our patient is able to swallow it’s better to give him oral else iv infusions are just enough no need for transdermal patches allergy to morphine is not vague so it’s not a genuine allergy because as we’ve seen that he’s given hydromorphone and he’s not uh giving allergic symptoms so his allergy is not vague so we consider this allergy as not genuine

Also the constipation is treated with multiple drugs of same class so we can maximize the use of a strong drug in place of the multiple regimens there is no need of giving two pca bonus to the patient one is 50 to 75 in a day and the other is 48 pca bowlers in a day instead what we will do is we will give 4 mg per hour that is 96 pca per day it’s more effective

As 4 mg per hour is going with the body and maintaining the um pain and managing the pain what is pca pca is actually a patient control analgesic what happens in it is a patient has a control button each time he presses it the dose is administered uh into the body uh because 4mg would be administered in a body at a time but give better results the next

Thing is when we are using iv infusions there is no need of transdermal opioids we will use oral uh opioids if the patient is stable and and he is able to swallow it but if our patient is not stable we will give iv infusions that should be just enough the next thing is the patient should be switched to morphine if no real allergy exists because hydromorphones

Are reserved for only genuine allergies and also the morphine is more cheap drug and more economic for the patient for constipation this regimen current management that he is using has four medications for constipation but they are still not helpful the four medications include sena lactulose docusate sodium and miralex senna is an stimulant what we will do in

It is we will increase the dose from two diets the id to four tablets bid for better results the lactic leos lecture levels should be switched with sorbitol sorbitol concentration should be 30 to 150 ml once sorbitol is more economic so we are replacing or switching it with lecture loss in between docusates sodium and miralex they both are true softness we can

Escape torque you see its sodium because miralax is more potent drug metroclopramide treats nausea and vomiting so we can skip or exclude lorazepam metaclopramide treats nausea and vomiting so we can skip lorazepam also the metropolite treat hiccups and constipation but with a condition that our patient should have slow bubble movement or an hypoactive bubble so

That means we can skip battlefin too so summarizing it we can say that we have decreased the dose of pca from more than 100 pca per day to 96 pca per day we have excluded transdermal opioids we have increased the dose of senna from two tablets bid to four tablets bid we have switched uh lecture loss with sorbitol we have excluded docusate sodium we have excluded

Japan and also baclofen thank you

Transcribed from video
End stage life care management and palliative sedation By Pharmacy by Dr. Shahana wahid