GROUP 4 PALLIATIVE care and hospice.pptx

Detailed introduction to palliative care principles

1. PALLIATIVE CARE GROUP 4

2. GROUP MEMBERS SSENKUNGU NASSIF HUSSEIN .. 2022.04.10358 OPIO DANIEL ….. 2021.08.07993 ASHRAF HAMIS….. 2022.04.10175 AKONG HOPE MILLY …… 2022.04.10366

3. QUESTION Manage common symptoms seen in a palliative care setting based on the pathophysiological basis of the symptom.

4. In palliative care, symptoms arise due to advanced disease, multi-organ dysfunction, or treatment side effects. Management is best understood when linked to the pathophysiological basis of each symptom.

5. 1. PAIN Pathophysiology: Nociceptive pain: from tissue injury (somatic or visceral). Neuropathic pain: from nerve damage or infiltration. Mixed mechanisms in cancer and advanced organ failure.

6. MANAGEMENT . Nociceptive pain: Paracetamol, NSAIDs, opioids (morphine, oxycodone). Neuropathic pain: Anticonvulsants (gabapentin, pregabalin), antidepressants (amitriptyline, duloxetine). Adjuvants: corticosteroids (for bone/liver capsular pain), bisphosphonates/radiotherapy (bone metastases). Non-pharmacological: positioning, physiotherapy, psychological support.

7. 2. DYSPNEA[BREATHLESSNESS] Pathophysiology: From increased work of breathing, hypoxemia, hypercapnia, fluid overload, airway obstruction, or anxiety component. Management: Treat underlying cause if possible (e.g., diuretics for pulmonary edema, antibiotics for infection, bronchodilators for obstruction). Opioids (morphine) : reduce perception of dyspnea by central action. Oxygen: only if hypoxemic (not for all). Benzodiazepines (lorazepam, midazolam): for anxiety component. Fan therapy, positioning, relaxation techniques

8. 3. NAUSEA AND VOMITING Pathophysiology: Different pathways activate the vomiting center: Chemical (chemoreceptor trigger zone: drugs, uremia, opioids). Gastric stasis/obstruction. Vestibular (motion, labyrinth irritation). Raised intracranial pressure. Cortical (anxiety, fear).

9. CONTINUATION Management: Dopamine antagonists (metoclopramide, haloperidol): chemical causes. Prokinetics (metoclopramide, domperidone): gastric stasis. Antihistamines/anticholinergics ( cyclizine , scopolamine): vestibular. Steroids (dexamethasone): raised ICP, hepatic capsular stretch. Benzodiazepines : cortical causes. Non-drug: small frequent meals, reducing strong odors.

10. 4 . CONSTIPATION Pathophysiology: Opioids → inhibit peristalsis. Immobility, poor intake, dehydration, bowel obstruction. Management: Always prescribe laxatives with opioids . Stimulant (senna, bisacodyl) + softener (docusate, lactulose). Osmotic (PEG, lactulose) if stool is hard. Rectal measures (suppositories, enemas) if severe. Mechanical obstruction → may require stenting or surgical palliation.

11. 5. FATIGUE Pathophysiology: Multifactorial: cytokine release, anemia, cachexia, depression, metabolic derangements (renal/hepatic failure). Management: Treat reversible causes (correct anemia, optimize electrolytes). Corticosteroids (short-term benefit in cancer-related fatigue). Psychostimulants (methylphenidate, modafinil) in selected cases. Energy conservation strategies, physiotherapy, counseling.

12. 6. ANOREXIA AND CACHEXIA Pathophysiology: Cytokine-driven catabolism, metabolic alterations, loss of lean body mass. Often refractory to aggressive feeding. Management: Small, frequent meals; high-calorie, high-protein foods. Appetite stimulants: corticosteroids (short-term), megestrol acetate. Omega-3 fatty acids (some benefit). Counseling for family to avoid distress of forced feeding.

13. ANXIETY, DEPRESSION, DELIRIUM Pathophysiology: Neurochemical imbalance, stress of illness, drug effects (opioids, steroids), metabolic disturbances. Management: Anxiety: benzodiazepines (lorazepam), relaxation therapy. Depression: SSRIs (sertraline), mirtazapine (also improves sleep and appetite). Delirium: antipsychotics (haloperidol, olanzapine); treat reversible causes (infection, metabolic derangements). Psychological, social, and spiritual support.

14. 8. SECRETIONS [ DEATH RATTLE ] Pathophysiology: Accumulation of saliva/bronchial secretions due to impaired swallowing and cough reflex near end of life. Management: Reassure family (often more distressing to them than the patient). Anticholinergics: glycopyrrolate, hyoscine butylbromide , atropine drops. Positioning (lateral decubitus), gentle suction (rarely needed).  

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