This document provides an overview of palliative care for first year medical students. It defines palliative care as improving quality of life for patients with life-threatening illnesses through pain and symptom management. Palliative care is not just end-of-life care and can benefit patients at any stage of illness. Hospice provides similar care but requires a prognosis of 6 months or less and is focused on comfort. The document discusses common symptoms patients may experience at end of life like pain, bleeding, and breathing issues and how physicians can address these symptoms.
This document provides information on evaluating patients presenting with fatigue, weakness, and weight loss. It reviews common differential diagnoses and recommended initial laboratory tests. Four clinical cases are presented and discussed. The first case involves an 80-year-old woman who presented with hematemesis, confusion, and a 10kg weight loss over 4 months. Her initial workup revealed anemia and elevated ESR, suggesting a serious underlying condition needs to be investigated.
An 83-year-old woman presented with fever, shortness of breath, and poor oral intake. She has a history of multiple medical conditions and is on several medications. On examination, she has a fever and signs of respiratory distress. The physician is concerned about pneumonia and increased depression, but her cognitive status was not assessed. Delirium is an acute fluctuating syndrome of altered attention, awareness and cognition, especially common in elderly hospitalized patients. It is often misdiagnosed as depression or dementia. Non-pharmacological prevention and treatment of underlying causes are most important, while antipsychotics may be used short-term for severe symptoms if needed.
The document discusses various treatment modalities in psychiatry including somatic (physical) therapies like psychopharmacology, electroconvulsive therapy, and psychosurgery. It provides details on specific psychotropic drugs like antipsychotics, antidepressants, mood stabilizers, anxiolytics, and their indications, mechanisms of action, dosages, side effects and the nurse's role in administering them. Electroconvulsive therapy is described as the artificial induction of seizures through electrical stimulation to treat severe depression, catatonia and psychosis.
This document discusses post-stroke depression. It notes that approximately 20-25% of stroke patients experience psychological symptoms initially from the shock and loss. Over time, patients must adjust to their new physical and cognitive limitations as well as changes in family roles and relationships. Post-stroke depression is common, affecting about one-third of patients, and is associated with poorer recovery outcomes, reduced quality of life, and increased mortality. Risk factors include a prior history of depression, female sex, social isolation, and greater functional impairment. Treatment involves antidepressants, psychotherapy, and lifestyle interventions, with the goal of improving mood and supporting recovery.
This presentation introduces you to the different types of depression. Though there are general symptoms seen in all types of depression, there are symptoms specific to a particular type. This presentation includes the symptoms for each type of depression.
Overview of Confusion & Delirium for Clinicians (July 2007)Alex J Mitchell
Delirium is a common and serious syndrome among hospitalized patients, with an incidence of 10-15% on admission and 5-40% developing delirium during hospitalization. It is characterized by acute onset and fluctuating features including inattention, disorganized thinking, and altered level of consciousness. Delirium is associated with poor outcomes including prolonged hospitalization, increased mortality rates up to 33% in hospital and 39% after discharge, and persistent symptoms in some patients for months or longer. Non-pharmacological management focuses on treating underlying causes, supportive care, and minimizing risk factors through proper nutrition, hydration, safety measures, and a calm environment with clear communication.
This document provides an overview of the management of schizophrenia according to the 11th Post Graduate Course in 2005 at the Institute of Psychiatry in Rawalpindi, Pakistan. It discusses the biological, psychological, and social aspects of schizophrenia management. Biologically, it describes the use of antipsychotic medications including both typical and atypical antipsychotics. Psychologically, it emphasizes individual psychotherapy, family education, and cognitive behavioral therapy. Socially, it stresses the importance of rehabilitation, social and vocational training, and case management.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
This document provides information on evaluating patients presenting with fatigue, weakness, and weight loss. It reviews common differential diagnoses and recommended initial laboratory tests. Four clinical cases are presented and discussed. The first case involves an 80-year-old woman who presented with hematemesis, confusion, and a 10kg weight loss over 4 months. Her initial workup revealed anemia and elevated ESR, suggesting a serious underlying condition needs to be investigated.
An 83-year-old woman presented with fever, shortness of breath, and poor oral intake. She has a history of multiple medical conditions and is on several medications. On examination, she has a fever and signs of respiratory distress. The physician is concerned about pneumonia and increased depression, but her cognitive status was not assessed. Delirium is an acute fluctuating syndrome of altered attention, awareness and cognition, especially common in elderly hospitalized patients. It is often misdiagnosed as depression or dementia. Non-pharmacological prevention and treatment of underlying causes are most important, while antipsychotics may be used short-term for severe symptoms if needed.
The document discusses various treatment modalities in psychiatry including somatic (physical) therapies like psychopharmacology, electroconvulsive therapy, and psychosurgery. It provides details on specific psychotropic drugs like antipsychotics, antidepressants, mood stabilizers, anxiolytics, and their indications, mechanisms of action, dosages, side effects and the nurse's role in administering them. Electroconvulsive therapy is described as the artificial induction of seizures through electrical stimulation to treat severe depression, catatonia and psychosis.
This document discusses post-stroke depression. It notes that approximately 20-25% of stroke patients experience psychological symptoms initially from the shock and loss. Over time, patients must adjust to their new physical and cognitive limitations as well as changes in family roles and relationships. Post-stroke depression is common, affecting about one-third of patients, and is associated with poorer recovery outcomes, reduced quality of life, and increased mortality. Risk factors include a prior history of depression, female sex, social isolation, and greater functional impairment. Treatment involves antidepressants, psychotherapy, and lifestyle interventions, with the goal of improving mood and supporting recovery.
This presentation introduces you to the different types of depression. Though there are general symptoms seen in all types of depression, there are symptoms specific to a particular type. This presentation includes the symptoms for each type of depression.
Overview of Confusion & Delirium for Clinicians (July 2007)Alex J Mitchell
Delirium is a common and serious syndrome among hospitalized patients, with an incidence of 10-15% on admission and 5-40% developing delirium during hospitalization. It is characterized by acute onset and fluctuating features including inattention, disorganized thinking, and altered level of consciousness. Delirium is associated with poor outcomes including prolonged hospitalization, increased mortality rates up to 33% in hospital and 39% after discharge, and persistent symptoms in some patients for months or longer. Non-pharmacological management focuses on treating underlying causes, supportive care, and minimizing risk factors through proper nutrition, hydration, safety measures, and a calm environment with clear communication.
This document provides an overview of the management of schizophrenia according to the 11th Post Graduate Course in 2005 at the Institute of Psychiatry in Rawalpindi, Pakistan. It discusses the biological, psychological, and social aspects of schizophrenia management. Biologically, it describes the use of antipsychotic medications including both typical and atypical antipsychotics. Psychologically, it emphasizes individual psychotherapy, family education, and cognitive behavioral therapy. Socially, it stresses the importance of rehabilitation, social and vocational training, and case management.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
This document discusses depression and its prevalence in India and neurological clinics. It provides criteria for diagnosing a major depressive episode according to DSM-5 and notes challenges in diagnosis for neurologists. Signs, symptoms, and treatment approaches for depression are also outlined. The document concludes by discussing depression associated with specific neurological disorders like Parkinson's disease.
This document summarizes guidelines for managing schizophrenia through pharmacological and psychosocial treatment. It discusses using antipsychotic medications such as second generation antipsychotics for acute episodes and maintaining treatment. Clozapine is recommended for treatment-resistant cases. Psychosocial interventions like family therapy, cognitive behavioral therapy, social skills training, supported employment, and substance abuse rehabilitation are described. Long-acting injectable antipsychotics can help with treatment adherence. The overall goal of management is achieving remission of symptoms and optimal functioning through a combination of medical and psychosocial support.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
Neuropsychiatric Aspects of Parkinson's DiseaseAbinayaa Arasu
This document provides an overview of neuropsychiatric manifestations of Parkinson's disease. It discusses common conditions like depression, anxiety, apathy, psychosis, impulse control disorders, sleep disorders, and dementia. Depression is one of the most prevalent neuropsychiatric symptoms, affecting up to 90% of patients. Anxiety, apathy, and impulse control disorders are also linked to dopaminergic medications. The document outlines risk factors, diagnostic tools, and treatment approaches for each condition. Overall, it comprehensively reviews the wide range of neuropsychiatric issues that can arise for patients with Parkinson's disease.
This document outlines guidelines for psychiatric management according to the APA. It discusses assessing symptoms and establishing a diagnosis, formulating and implementing a treatment plan, developing therapeutic alliance and promoting treatment adherence, providing patient and family education and therapies, treating comorbid conditions, attending to social circumstances and functioning, integrating treatments from multiple clinicians, and carefully documenting treatment. It then provides more detailed guidance on specific aspects of establishing a diagnosis, developing a treatment plan, promoting adherence, educating patients and families, and monitoring health during treatment.
Delirium tremens (DT) is a severe form of alcohol withdrawal that can be fatal if not promptly recognized and treated. It involves excessive nervous system excitability and is characterized by agitation, confusion, hallucinations, fever, and autonomic symptoms. Chronic heavy alcohol use affects neurotransmitter systems in the brain like GABA and glutamate. When alcohol is stopped, this can cause symptoms like tremors, seizures, and delirium as the brain adapts. The CIWA-Ar scale is used to assess alcohol withdrawal severity and guide treatment decisions.
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
Depression Explained by Ashutosh P Jadhav.
an Amazing presentation for Awareness of Depression,
and explained in detail what is Depression.
DO share with others.
A short slide share on the topic schizophrenia, a mental health condition Its discusses the types oy schizophrenia, sign and symptoms, causes and treatment with management .
This document discusses alcohol withdrawal, including its goals, evaluation and treatment. It describes the symptoms of withdrawal which can range from minor (insomnia, anxiety) to severe (delirium tremens). It recommends correcting fluid/electrolyte abnormalities and using a tapering regimen of benzodiazepines like chlordiazepoxide or diazepam to safely manage withdrawal symptoms. Adjunct medications like clonidine may also help. Close monitoring is needed as untreated severe withdrawal can be life-threatening.
This document discusses post-stroke psychiatric disorders. It describes five frontosubcortical circuits that are involved in cognition, behavior and movement. Common post-stroke psychiatric conditions include depression, anxiety, apathy, psychosis and pathological laughing/crying. Lesion location can impact the type of psychiatric disorder, such as left anterior lesions increasing risk of depression. Treatment involves pharmacotherapy, such as antidepressants, and psychotherapy. Screening and ongoing monitoring of symptoms is important after a stroke to identify and manage post-stroke psychiatric complications.
This document discusses the treatment of psychiatric disorders through pharmacotherapy, psychotherapy, and somatic treatments. It focuses on the role of medications in treating various conditions like mood disorders, schizophrenia, anxiety, sleep disorders, substance use disorders, and others. It provides details on specific drug classes and examples used to treat each condition. It also covers electroconvulsive therapy (ECT) and discusses what it is, how it works, when it may be used, potential side effects, and the ECT administration and recovery process. Psychotherapies are also mentioned as important treatment options.
The patient is a 63-year-old male with a history of alcohol abuse presenting with symptoms of acute alcohol withdrawal including tremors, anxiety, tachycardia and hypokalemia. Initial treatment involves monitoring, managing withdrawal symptoms, addressing nutritional deficits and providing counseling and referrals to support ongoing sobriety and prevent relapse.
Delirium is a neuropsychiatric syndrome characterized by acute onset of fluctuating cognitive impairment and changes in consciousness. It is common in medically ill patients and often misdiagnosed as psychiatric. Delirium is caused by underlying medical conditions and assessed using DSM criteria of disturbance in attention, cognition, and perception developing over short period. Treatment involves addressing underlying causes, managing symptoms like agitation, and preventing complications through reorientation and family support.
Schizophrenia (Biochemical Basis of Metabolic Disorders and its Cure)Sanjeev Mishra
This document provides an overview of schizophrenia, including its epidemiology, types, symptoms, diagnosis, and treatment. Some key points:
- Schizophrenia is a serious mental disorder that causes abnormal interpretations of reality and can result in hallucinations, delusions, and disordered thinking.
- It has a prevalence of 0.6-1.9% and most commonly occurs in late adolescence to early adulthood.
- The main types are paranoid, catatonic, disorganized, residual, and undifferentiated schizophrenia. Symptoms are divided into positive, negative, and cognitive clusters.
- Diagnosis involves evaluating symptoms, medical history, tests to rule out other conditions,
Delirium is an acute, potentially reversible brain dysfunction manifested by neuropsychiatric symptoms. It is common in hospitalized elderly patients, post-operatively, and in those withdrawing from alcohol. Core features include impaired consciousness, attention, cognition, and perception. Treatment involves identifying and addressing underlying causes, providing supportive care and reorientation, and administering antipsychotic medications like haloperidol to treat the delirium itself. Prognosis depends on severity and underlying causes, with higher mortality risks for those with longer or persistent delirium.
Effective treatment in depression and anxietyHarsh shaH
The document discusses mechanisms, types, symptoms, and treatment approaches for anxiety and depression. It provides details on specific medications including SSRIs (fluoxetine, fluvoxamine, paroxetine, sertaline, citalopram, escitalopram), paroxetine, escitalopram, desvenlafaxine, dosages, indications, mechanisms of action, efficacy, adverse effects, and warnings/precautions for safe use. Combination therapy with escitalopram and L-methylfolate is also rationale given their complementary mechanisms for enhancing neurotransmitter production and treatment response.
Depressive illness can be characterized by a major depressive episode involving depressed mood and loss of interest for at least two weeks, accompanied by additional symptoms. Depression is a significant contributor to the global disease burden. The lifetime risk of developing a severe depressive episode is 12-16%. Neurobiological factors like the GSK3beta gene and decreased levels of brain-derived neurotrophic factor are implicated in depression. Physical symptoms are commonly the chief complaint in depressed patients, and there is overlap in the neurochemistry of depression and pain involving serotonin and norepinephrine. Untreated somatic depression can lead to structural brain changes and increased risk of persistent pain.
This document provides information about space occupying lesions (SOLs) such as brain tumors and abscesses. It defines SOLs as tumors or abscesses within the skull that compress brain tissue. The document discusses the epidemiology, types, risk factors, signs and symptoms, diagnostic evaluation, medical and surgical management, nursing care and complications of different SOLs. It provides detailed information about various brain tumors and abscesses, including definitions and characteristics.
This document discusses the management of schizophrenia. It notes that early intervention is important for better outcomes. General practitioners should make an initial assessment of a patient's symptoms and functioning before referring them to a psychiatrist for diagnosis. The main treatment involves antipsychotic medication, including both typical and atypical drugs. Hospitalization may be required based on symptom severity and risk factors. Treatment also involves psychosocial support and educating family members. Electroconvulsive therapy can be effective for catatonia or severe depression associated with schizophrenia. Antidepressants may also be used for mood symptoms. The overall approach involves both medication and psychosocial support.
Palliative care services into an existing oncology programme by john weruKesho Conference
This study assessed clinician understanding of integrating palliative care into an oncology program. Clinicians were surveyed on indicators of successful integration across clinical processes, education, research, and ethics. Clinical processes had the highest agreement rate. Recommendations include the need for palliative care training, research, and integrated co-management to improve patient outcomes and experiences.
Withholding and withdrawal of medical therapies Jelisa1975
This document discusses the complex ethical and legal issues surrounding the withholding or withdrawal of life-sustaining medical treatments. It addresses key definitions, considerations regarding patient autonomy and provider responsibilities, relevant policies and acts, and two case studies that illustrate common dilemmas providers may face. Overall, the document stresses the importance of open communication, compassion, and ensuring the dignity and self-determination of the patient in all end-of-life medical decisions and care.
This document discusses depression and its prevalence in India and neurological clinics. It provides criteria for diagnosing a major depressive episode according to DSM-5 and notes challenges in diagnosis for neurologists. Signs, symptoms, and treatment approaches for depression are also outlined. The document concludes by discussing depression associated with specific neurological disorders like Parkinson's disease.
This document summarizes guidelines for managing schizophrenia through pharmacological and psychosocial treatment. It discusses using antipsychotic medications such as second generation antipsychotics for acute episodes and maintaining treatment. Clozapine is recommended for treatment-resistant cases. Psychosocial interventions like family therapy, cognitive behavioral therapy, social skills training, supported employment, and substance abuse rehabilitation are described. Long-acting injectable antipsychotics can help with treatment adherence. The overall goal of management is achieving remission of symptoms and optimal functioning through a combination of medical and psychosocial support.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
Neuropsychiatric Aspects of Parkinson's DiseaseAbinayaa Arasu
This document provides an overview of neuropsychiatric manifestations of Parkinson's disease. It discusses common conditions like depression, anxiety, apathy, psychosis, impulse control disorders, sleep disorders, and dementia. Depression is one of the most prevalent neuropsychiatric symptoms, affecting up to 90% of patients. Anxiety, apathy, and impulse control disorders are also linked to dopaminergic medications. The document outlines risk factors, diagnostic tools, and treatment approaches for each condition. Overall, it comprehensively reviews the wide range of neuropsychiatric issues that can arise for patients with Parkinson's disease.
This document outlines guidelines for psychiatric management according to the APA. It discusses assessing symptoms and establishing a diagnosis, formulating and implementing a treatment plan, developing therapeutic alliance and promoting treatment adherence, providing patient and family education and therapies, treating comorbid conditions, attending to social circumstances and functioning, integrating treatments from multiple clinicians, and carefully documenting treatment. It then provides more detailed guidance on specific aspects of establishing a diagnosis, developing a treatment plan, promoting adherence, educating patients and families, and monitoring health during treatment.
Delirium tremens (DT) is a severe form of alcohol withdrawal that can be fatal if not promptly recognized and treated. It involves excessive nervous system excitability and is characterized by agitation, confusion, hallucinations, fever, and autonomic symptoms. Chronic heavy alcohol use affects neurotransmitter systems in the brain like GABA and glutamate. When alcohol is stopped, this can cause symptoms like tremors, seizures, and delirium as the brain adapts. The CIWA-Ar scale is used to assess alcohol withdrawal severity and guide treatment decisions.
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
Depression Explained by Ashutosh P Jadhav.
an Amazing presentation for Awareness of Depression,
and explained in detail what is Depression.
DO share with others.
A short slide share on the topic schizophrenia, a mental health condition Its discusses the types oy schizophrenia, sign and symptoms, causes and treatment with management .
This document discusses alcohol withdrawal, including its goals, evaluation and treatment. It describes the symptoms of withdrawal which can range from minor (insomnia, anxiety) to severe (delirium tremens). It recommends correcting fluid/electrolyte abnormalities and using a tapering regimen of benzodiazepines like chlordiazepoxide or diazepam to safely manage withdrawal symptoms. Adjunct medications like clonidine may also help. Close monitoring is needed as untreated severe withdrawal can be life-threatening.
This document discusses post-stroke psychiatric disorders. It describes five frontosubcortical circuits that are involved in cognition, behavior and movement. Common post-stroke psychiatric conditions include depression, anxiety, apathy, psychosis and pathological laughing/crying. Lesion location can impact the type of psychiatric disorder, such as left anterior lesions increasing risk of depression. Treatment involves pharmacotherapy, such as antidepressants, and psychotherapy. Screening and ongoing monitoring of symptoms is important after a stroke to identify and manage post-stroke psychiatric complications.
This document discusses the treatment of psychiatric disorders through pharmacotherapy, psychotherapy, and somatic treatments. It focuses on the role of medications in treating various conditions like mood disorders, schizophrenia, anxiety, sleep disorders, substance use disorders, and others. It provides details on specific drug classes and examples used to treat each condition. It also covers electroconvulsive therapy (ECT) and discusses what it is, how it works, when it may be used, potential side effects, and the ECT administration and recovery process. Psychotherapies are also mentioned as important treatment options.
The patient is a 63-year-old male with a history of alcohol abuse presenting with symptoms of acute alcohol withdrawal including tremors, anxiety, tachycardia and hypokalemia. Initial treatment involves monitoring, managing withdrawal symptoms, addressing nutritional deficits and providing counseling and referrals to support ongoing sobriety and prevent relapse.
Delirium is a neuropsychiatric syndrome characterized by acute onset of fluctuating cognitive impairment and changes in consciousness. It is common in medically ill patients and often misdiagnosed as psychiatric. Delirium is caused by underlying medical conditions and assessed using DSM criteria of disturbance in attention, cognition, and perception developing over short period. Treatment involves addressing underlying causes, managing symptoms like agitation, and preventing complications through reorientation and family support.
Schizophrenia (Biochemical Basis of Metabolic Disorders and its Cure)Sanjeev Mishra
This document provides an overview of schizophrenia, including its epidemiology, types, symptoms, diagnosis, and treatment. Some key points:
- Schizophrenia is a serious mental disorder that causes abnormal interpretations of reality and can result in hallucinations, delusions, and disordered thinking.
- It has a prevalence of 0.6-1.9% and most commonly occurs in late adolescence to early adulthood.
- The main types are paranoid, catatonic, disorganized, residual, and undifferentiated schizophrenia. Symptoms are divided into positive, negative, and cognitive clusters.
- Diagnosis involves evaluating symptoms, medical history, tests to rule out other conditions,
Delirium is an acute, potentially reversible brain dysfunction manifested by neuropsychiatric symptoms. It is common in hospitalized elderly patients, post-operatively, and in those withdrawing from alcohol. Core features include impaired consciousness, attention, cognition, and perception. Treatment involves identifying and addressing underlying causes, providing supportive care and reorientation, and administering antipsychotic medications like haloperidol to treat the delirium itself. Prognosis depends on severity and underlying causes, with higher mortality risks for those with longer or persistent delirium.
Effective treatment in depression and anxietyHarsh shaH
The document discusses mechanisms, types, symptoms, and treatment approaches for anxiety and depression. It provides details on specific medications including SSRIs (fluoxetine, fluvoxamine, paroxetine, sertaline, citalopram, escitalopram), paroxetine, escitalopram, desvenlafaxine, dosages, indications, mechanisms of action, efficacy, adverse effects, and warnings/precautions for safe use. Combination therapy with escitalopram and L-methylfolate is also rationale given their complementary mechanisms for enhancing neurotransmitter production and treatment response.
Depressive illness can be characterized by a major depressive episode involving depressed mood and loss of interest for at least two weeks, accompanied by additional symptoms. Depression is a significant contributor to the global disease burden. The lifetime risk of developing a severe depressive episode is 12-16%. Neurobiological factors like the GSK3beta gene and decreased levels of brain-derived neurotrophic factor are implicated in depression. Physical symptoms are commonly the chief complaint in depressed patients, and there is overlap in the neurochemistry of depression and pain involving serotonin and norepinephrine. Untreated somatic depression can lead to structural brain changes and increased risk of persistent pain.
This document provides information about space occupying lesions (SOLs) such as brain tumors and abscesses. It defines SOLs as tumors or abscesses within the skull that compress brain tissue. The document discusses the epidemiology, types, risk factors, signs and symptoms, diagnostic evaluation, medical and surgical management, nursing care and complications of different SOLs. It provides detailed information about various brain tumors and abscesses, including definitions and characteristics.
This document discusses the management of schizophrenia. It notes that early intervention is important for better outcomes. General practitioners should make an initial assessment of a patient's symptoms and functioning before referring them to a psychiatrist for diagnosis. The main treatment involves antipsychotic medication, including both typical and atypical drugs. Hospitalization may be required based on symptom severity and risk factors. Treatment also involves psychosocial support and educating family members. Electroconvulsive therapy can be effective for catatonia or severe depression associated with schizophrenia. Antidepressants may also be used for mood symptoms. The overall approach involves both medication and psychosocial support.
Palliative care services into an existing oncology programme by john weruKesho Conference
This study assessed clinician understanding of integrating palliative care into an oncology program. Clinicians were surveyed on indicators of successful integration across clinical processes, education, research, and ethics. Clinical processes had the highest agreement rate. Recommendations include the need for palliative care training, research, and integrated co-management to improve patient outcomes and experiences.
Withholding and withdrawal of medical therapies Jelisa1975
This document discusses the complex ethical and legal issues surrounding the withholding or withdrawal of life-sustaining medical treatments. It addresses key definitions, considerations regarding patient autonomy and provider responsibilities, relevant policies and acts, and two case studies that illustrate common dilemmas providers may face. Overall, the document stresses the importance of open communication, compassion, and ensuring the dignity and self-determination of the patient in all end-of-life medical decisions and care.
This document contains short summaries of topics related to palliative care, including that palliative care means more than end-of-life care, discussing spirituality with patients, and emphasizing the biopsychosocial approach to care. Each summary is dedicated in honor of individuals who have contributed to the field.
This document discusses effective pain management and the challenges of treating chronic pain with opioids. It provides an overview of pain management principles, the risks of addiction, and approaches to assessing patients and monitoring opioid treatment. While opioids can help treat pain in some cases, providers must consider the risks and benefits for each patient due to the potential for abuse, addiction and undertreatment of pain.
This document discusses opioid receptors and their effects when activated, including opening potassium channels, closing calcium channels, and reducing neurotransmitter release. It then describes various opioid analgesics that are μ receptor agonists like morphine, methadone, fentanyl, and heroin. The document also discusses the organ system effects of full opioid agonists such as analgesia, euphoria, sedation, respiratory depression, and others. Codeine and buprenorphine are also described.
This document provides an overview of pain management and opioid use for cancer patients. It discusses how cancer pain is common and should be properly assessed and treated. The WHO pain ladder is reviewed as the standard approach for treating pain with non-opioids, weak opioids, and strong opioids. Opioid rotation and treating pain crises are covered, including calculating opioid conversions and administering parenteral opioids. Challenges in treating cancer pain in patients with addiction histories are addressed through transparency, long-acting opioids, and pain contracts. Overall guidelines aim to properly treat pain while avoiding exacerbating addiction issues.
Cancer pain is caused by tumors invading tissues and pressing on nerves. There are three types of pain: nociceptive, inflammatory, and neuropathic. Pain signals travel along nerve pathways from tissues to the spinal cord and brain. Cancer pain management involves detailed assessment, analgesic drugs like opioids, and non-pharmacological treatments. Radiation, chemotherapy, surgery, nerve blocks, and cement injections can help reduce tumor size and pressure causing pain. The goal is comprehensive treatment of physical and psychological distress from cancer.
This document discusses cancer pain, its causes, types, prevalence among cancer patients, diagnosis, and management. It states that moderate to severe pain is experienced by 40-50% of cancer patients, while very severe pain affects 25-30%. Pain management methods discussed include radiation therapy, chemotherapy, hormone therapy, bisphosphonates, surgery, complementary therapies like acupuncture and massage, and use of the WHO pain ladder for pharmacological treatments. It also covers mucositis, chemotherapy-induced peripheral neuropathy, and the use of non-analgesic drugs to manage certain painful conditions in cancer patients.
Interventional Techniques For Cancer Pain Management.guest7342323
The document discusses cancer pain management techniques including conservative management and interventional techniques. It covers assessing pain, diagnosing the type and cause of pain, and treating pain using the WHO analgesic ladder as well as more advanced interventional techniques like intraspinal opioid administration, radiofrequency ablation, vertebroplasty, and neurolytic blocks. The goal is to properly diagnose and treat different types of cancer pain to improve patients' quality of life.
Delirium is a common and serious condition experienced by up to 85% of terminally ill cancer patients. It causes cognitive impairment, increased hospital stays and costs, worse patient and caregiver outcomes, and conflicts with patient goals of cognitive awareness at the end of life. Delirium has multiple potential causes including medications, metabolic imbalances, infections, and environmental changes. It is reversible in about 50% of cases with treatment of underlying causes and both pharmacological and non-pharmacological interventions. Early recognition and treatment are important for managing delirium and its impacts.
This document provides guidance on evaluating patients presenting with dyspnea (shortness of breath). It defines dyspnea and lists some specific types based on position. Common causes are outlined for pulmonary, cardiac, mixed, and non-cardiopulmonary origins. A clinical approach is described beginning with vital signs and history, followed by physical exam focusing on respiratory, cardiac, and fluid status findings. Initial investigations include chest X-ray, blood gases, ECG, and blood tests. Further tests may include lung function, exercise testing, and biomarkers to differentiate cardiac from pulmonary causes when the chest X-ray is normal. Careful history taking and physical exam remain important to identify underlying conditions.
This document provides an overview of dyspnea, or shortness of breath. It defines dyspnea and outlines its physiological and clinical definitions. Common causes of dyspnea are then discussed, including pulmonary issues like COPD, pneumonia, and pulmonary embolism, as well as cardiac issues like heart failure, coronary syndromes, and dysrhythmias. The pathophysiology of how these conditions can stimulate breathing and cause the sensation of dyspnea is explained. Finally, the document discusses assessing and diagnosing patients presenting with dyspnea through clinical exams, investigations like chest x-rays, and determining if the cause is chronic or acute.
Pain is the common symptom in many chronic conditions such as cancers, neuropathies, and chronic disease. It is also experienced in trauma varying from mild to severe based on the location and degree of trauma. This presentation is a brief outline on types of pain, classification of pain, pain pathways and management of pain
This document discusses pain and its treatment. It begins by defining pain and classifying common types of pain conditions. It then discusses the body's reflex responses to pain and the endorphin system that modulates pain. It describes the differences between acute and chronic pain and methods of pain measurement. Various treatment options are provided for different types of pain, including NSAIDs, opioids, tramadol, tapentadol, muscle relaxants, and sodium channel blockers. Newer treatments discussed include epirisone and the comparative properties of different NSAIDs, muscle relaxants, tramadol, and tapentadol. Key questions are also provided about comparing treatment effectiveness and safety across patient subgroups.
This document provides an overview of pain, including definitions, classifications, physiology, assessment, and management. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is classified based on location, duration (acute vs chronic), and intensity (mild, moderate, severe). The physiology of pain involves transduction, transmission, modulation, and perception of pain signals in the nervous system. Nurses assess pain using scales and treat it using pharmacological and non-pharmacological methods based on the type and severity of the pain.
Building on the lecture I gave (and uploaded) "Palliative Care: what every primary care doctor should know" I built this talk. It is geared for 1st year medical students who are learning anatomy, physiology, and perhaps some pharmacology and pathophysiology.
In this talk, I do not explicitly address hospice care - as that was provided in an online chapter for students at UMass. I will later upload another slide set on that topic.
I hope you enjoy it.
FYI- the link to the youtube video: http://www.youtube.com/watch?v=XHtHXGhTIC4
Link to PDF of the slide show: https://files.me.com/s.mak/8fzat6
Palliative care aims to improve quality of life for patients with life-limiting illnesses through early identification and treatment of pain and other symptoms. Palliative care takes a holistic approach addressing physical, psychosocial and spiritual needs. Dyspnea, or breathlessness, is a common and distressing symptom experienced by over 50% of hospice patients. A thorough history and assessment of dyspnea is important to identify potential causes and guide treatment options. Both non-pharmacological and pharmacological interventions can provide relief, including opioids, benzodiazepines, oxygen, bronchodilators, and corticosteroids. Active management of dyspnea is important during the last hours of life to minimize suffering.
Palliative care for family medicine trainees 2015Chai-Eng Tan
This document provides an overview of palliative care for family medicine trainees. It defines palliative care as improving quality of life for patients and families facing life-threatening illness. It discusses pain control using the WHO analgesic ladder and managing non-pain symptoms. It covers prognostication using performance status scales and discussing prognosis with patients. Finally, it describes the role of community-based palliative care providers in delivering multidisciplinary care to allow patients to die at home.
Palliative care in head and neck cancerSneha Shekhar
- Palliative care aims to improve quality of life for patients facing life-threatening illness through prevention and relief of suffering via early identification and treatment of pain and other physical, psychosocial and spiritual problems.
- It can begin at diagnosis alongside curative treatment and continues even if curative treatment is no longer an option.
- A multidisciplinary team addresses common issues in head and neck cancer like pain, dysphagia, malnutrition, secretions, and side effects of treatment through pharmacological, nutritional, physical and psychosocial support.
This case study describes the end-of-life care of Lorna, a 77-year old woman with metastatic renal cell carcinoma. Lorna originally presented with flank and abdominal pain and was diagnosed with advanced renal cell carcinoma in 2011. In 2014, the cancer recurred and metastasized to her spine, causing cauda equina syndrome with lower limb weakness and urinary/fecal incontinence. She was admitted to palliative care for pain and symptom management, where she received psychological support, medication via syringe pump, and focus on comfort. The document discusses renal cell carcinoma, cauda equina syndrome, medications, nursing interventions and compassionate end-of-life care.
This document discusses emergencies and management in the last 48 hours of life in palliative care. It covers spinal cord compression, hypercalcemia of malignancy, and superior vena cava syndrome as common emergencies. For the last 48 hours, the goals are comfort, communication, and preparation for death. Symptoms addressed include weakness, secretions, pain, agitation, incontinence, and breathing issues. Care focuses on hydration, nutrition, oral hygiene, skin care, positioning, and supporting family members.
The document provides guidance on caring for dying patients. It discusses recognizing hope at end-of-life, assessing patients, and managing common symptoms in the last months, weeks, days, and hours of life such as pain, breathing issues, nausea, secretions, and psychological concerns. Effective care involves addressing the patient's symptoms, needs, and goals through both medical management and comforting the patient and family.
Palliative care aims to improve quality of life for patients facing life-limiting illness and their families through pain and symptom management, psychosocial and spiritual support from diagnosis until end of life. It focuses on preventing and relieving suffering through early identification and treatment of pain, and addresses physical, psychosocial and spiritual problems. Palliative care is applicable alongside curative treatments and aims neither to hasten nor postpone death.
Long term side effects of cancer treatment - Catherine Masterson & Mary DowdIrish Cancer Society
1) Cancer treatments can cause long term side effects like cancer related fatigue, chemotherapy induced peripheral neuropathy, and chemotherapy-related cognitive impairment.
2) Cancer related fatigue is a daily lack of energy that is not relieved by sleep and can be caused by both the disease and its treatments. It affects about 40% of breast cancer survivors.
3) Chemotherapy induced peripheral neuropathy causes nerve damage that results in numbness, tingling, and pain in the extremities, and can progress over time or with additional chemotherapy treatments.
This document discusses various topics related to end of life care, including palliative care, hospice care, end of life in the ICU, common symptoms at end of life, and their management. It addresses pain management, including assessment of pain and the WHO pain ladder. It also discusses management of other common symptoms like nausea/vomiting, dyspnea, fatigue, anorexia/cachexia, depression, delirium, and euthanasia. Important court cases related to passive euthanasia in India and other countries are also summarized.
Palliative Medicine in Alzheimer's disease and other dementia disordersruparnakhurana
Integration of palliative medicine in advanced neurological disorders like dementia, motor neuron disease, multiple sclerosis, amyotrophic lateral sclerosis, stroke is the need of the hour as these patients have a progressive incurable illness with heavy symptom burden and psychosocial implications
Our errors in diagnosing dizziness slidesBest Doctors
This document summarizes a webinar on diagnosing dizziness presented by Best Doctors. It includes:
1) Four case studies on misdiagnoses of dizziness presented by Drs. Samuels, Calkins, Megerian, and Derebery focusing on conditions like pheochromocytoma, postural orthostatic tachycardia syndrome, endolymphatic sac tumor, and migraine-associated vertigo.
2) A discussion by Dr. Derebery of the differential diagnosis of dizziness and approaches to diagnosis based on temporal patterns and urgency.
3) Details on ACCME accreditation and speaker disclosures for continuing education credits.
Three hour slide deck for basics of palliative care including what is palliative care, symptom management (pain, dyspnea, nausea, constipation), goals-of-care, family meetings, comfort care, and issues around artificial nutrition.
This document provides information about palliative care and comfort care at the end of life. It discusses palliative care as improving quality of life for those with life-threatening illness through pain and symptom relief. Comfort care is care that helps or soothes those who are dying with the goal of preventing and relieving suffering while respecting wishes. The document provides guidance on identifying actively dying patients, managing pain and dyspnea with opioids, and using continuous opioid infusions.
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
This document discusses depression, including its definition, statistics, types, causes, consequences, role of neurotransmitters, treatment options like medication and cognitive behavioral therapy. It defines depression and differentiates it from normal sadness. It covers diagnostic criteria, risk factors, and treatments including antidepressant medications, electroconvulsive therapy, light therapy, and cognitive behavioral therapy. Relapse prevention and the importance of continued treatment are also discussed.
Similar to Palliative Care in Oncology: What every 1st year medical student should know (20)
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
More@: https://tinyurl.com/5n8h3wp8
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...DrDevTaneja1
Digital India will need a big trained army of Health Informatics educated & trained manpower in India.
Presently, generalist IT manpower does most of the work in the healthcare industry in India. Academic Health Informatics education is not readily available at school & health university level or IT education institutions in India.
We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...Kumar Satyam
According to TechSci Research report, “India Medical Devices Market Industry Size, Share, Trends, Competition, Opportunity and Forecast, 2019-2029,” the India Medical Devices Market was valued at USD 15.35 billion in 2023 and is anticipated to witness impressive growth in the forecast period, with a Compound Annual Growth Rate (CAGR) of 5.35% through 2029. This growth is driven by various factors, including strategic collaborations and partnerships among leading companies, a growing population, and the increasing demand for advanced healthcare solutions.
Recent Trends
Strategic Collaborations and Partnerships
One of the most significant trends driving the India Medical Devices Market is the increasing number of collaborations and partnerships among leading companies. These alliances aim to merge the expertise of individual companies to strengthen their market position and enhance their product offerings. For instance, partnerships between local manufacturers and international companies bring advanced technologies and manufacturing techniques to the Indian market, fostering innovation and improving product quality.
Browse over XX market data Figures and spread through XX Pages and an in-depth TOC on " India Medical Devices Market.” - https://www.techsciresearch.com/report/india-medical-devices-market/8161.html
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
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Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
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Build Trust and Security:
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Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
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CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdf
Palliative Care in Oncology: What every 1st year medical student should know
1. Palliative Care:
What every 1st year medical
student needs to know
Suzana Makowski, MD MMM FACP FAAHPM
Assistant Professor of Medicine
Slide presentation for 1st year medical students in the Cancer Concepts Course at
UMass Medical School
2. Overview
• What is Palliative Care?
• What is Hospice?
• How do we care for the dying?
3. Palliative Care
“an approach that improves
the quality of life of
patients and their families
facing the problems
associated with life-
threatening illness, through
the prevention and relief of
suffering by means of early
identification and
impeccable assessment and
treatment of pain and other
problems, physical,
psychosocial and spiritual.”
WHO definition
4. Why discuss palliative care?
• “It’s not about killing
Granny; it’s about
keeping Granny alive as
long as possible — with
the best quality of life.”
- Diane Meier, NYTimes
5. NEJM Study (2010): Early Palliative Care improves longevity and
quality of life for patients with advanced non-small cell lung cancer
http://www.youtube.com/watch?v=XHtHXGhTIC4
11. Cancer pain prevalence
• 50 to 90 percent of oncology inpatients report
breakthrough pain
• 35 percent of community based oncology practices
patients report breakthrough pain
• 1 in 3 patients with active cancer report pain
• 3 out of 4 of patients with advanced cancer report pain
12. Causes of cancer pain
• Bone metastases
• Visceral metastases
• Immobility
• Neuropathic pain
• Soft tissue
• Constipation
• Esophagitis
• Lymphedema
• Muscle cramps
• Chronic postoperative scar
• Adapted from Twycross R, Harcourt J, Bergl S: A survey of pain in patients with
advanced cancer. J Pain Symptom Manage 1996;12:273-282.
13. Effects of under treated pain
Physical Emotional Existential
• Increased catabolic demands:
poor wound healing, weakness, muscle
breakdown
• Decreased limb movement:
increased risk of DVT/PE
• Respiratory effects:
shallow breathing, tachypnea, cough
suppression increasing risk of pneumonia and
atelectasis
• Sodium and water retention Decreased
gastrointestinal mobility
• Tachycardia and elevated blood pressure
• Decreased functional status
• Increased chronic pain
Depression
Anxiety
Decreased
intimacy
Suicidality
Suffering –
“why me?”
15. Pain Quality
Category Cause Symptom Examples
Physiologic Brief exposure to a
noxious stimulus
Rapid yet brief pain
perception
Touching a pin or hot
object
Nociceptive/infla
mmatory
Somatic or visceral tissue
injury with mediators
having an impact on
intact nervous tissue
Moderate to severe pain,
described as crushing or
stabbing
Surgical pain,
traumatic pain, sickle
cell crisis
Neuropathic
Damage or dysfunction
of peripheral nerves or
CNS
Severe lancinating,
burning or electrical
shock like pain
Neuropathy, CRPS.
Postherpetic Neuralgia
Mixed
Combined somatic and
nervous tissue injury
Combinations of
symptoms; soft tissue plus
radicular pain
Low back pain, back
surgery pain
17. Why is this dangerous?
• Mrs. Dolores de Barriga is a 67 year old Peruvian
immigrant with metastatic colon cancer, who has
increasing abdominal pain. She has a colostomy and has
regular bowel movements.
• Her current pain regimen is:
• Morphine ER 15mg twice daily
• Percocet (oxycodone 5mg + acetaminophen 500mg) – 1-2
tablets every 4 hours as needed. She has been taking 2
tablets every 4 hours for the last week.
19. Opioid Pharmacology
Short-acting Long-acting
• Hydrocodone/APAP
• Oxycodone +/- APAP
• Morphine
• Hydromorphone
• Oral transmucosal fentanyl
• Transdermal fentanyl
• methadone
• morphine ER
• oxycodone ER
• Cmax ~ 45 min
• T1/2 ~ 2-4 hours
• Except fentanyl
Cmax and T1/2 vary based on
formulation and drug
20. A quick quiz
What is the half life (range) for opioids?
• 2-4 hours
How many half lives to get to steady state?
• 4-5
What do you base your scheduled dosing on: Cmax or C?
• t1/2
What do you base your breakthrough dosing on: Cmax or t1/2?
• Cmax
21. Opioid pharmacology
(except methadone)
• Follow first order kinetics
• Conjugated by liver
• 90-95% excreted in urine
• Dehydration, renal failure, severe hepatic failure
• Decrease interval/dosing size
• If oliguria/anuria
• STOP routine dosing (basal rate) of morphine
• Use ONLY PRN
Why is morphine
contraindicated in
renal failure?
22. Morphine metabolites
build-up disproportionately in renal failure
• Morphine 3-glucoronide
• Not an opioid agonist
• Stimulates the GABA/glycinergic
system
• Can cause neuro-excitation –
agitation, hyperalgesia, myoclonus,
seizures.
• Morphine 6-glucoronide
• Active metabolite that acts as an
opioid agonist – especially against the
mu-opioid receptor
23. Palliative Care
• Same “rules” apply
• CMO ≠ Continuous Morphine Only
Optimal symptom
management
• Goals of care based
• Not problem based
Personalized
healthcare
• Bio-psycho-social-spiritual approach
• Interdisciplinary
Whole-person
care
24. Myth: Palliative care = “no more treatment”
We assess the values & goals of a patient, designing care around them
25.
26. Massachusetts facts
On an average day in Massachusetts:
144
people die
A few
childre
n
1
infant
Some
middle
aged
Most
over 75
29. Hospice care:
1 way to help stay home
• In the United States, hospice is a form of care provided to
patients whose life expectancy is 6 months or less.
• It is generally provided in the patient’s home, but can be
received in nursing homes, hospices houses, etc.
• It is a Medicare benefit (that many other insurances
cover)
• Its approach is to help people live as well as possible, for
the time they have left: alleviating symptoms, reaching
goals, supporting family, addressing spiritual needs.
• As long as a person’s prognosis remains 6 months, the
benefit does not run out.
• A patient may be “full code”, “DNR/DNI” – according to
their goals and preferences on hospice.
30. Hospice Home Palliative (VN)
Requires Prognosis <6months
(Not required: code status,
primary caregiver)
Home-bound only
Must show improvement
Services Nurse, social worker,
chaplain, volunteer, home
health aide
Nurse, PT/OT
DME* All covered Not covered
Meds Covered if associated with
dx
Not covered
Hours 24/7 Regular business hours
Other Bereavement for family up
to 13 months after death
None
*DME = durable medical equipment (bed, oxygen, commode, etc.)
34. What we know
• Until recently, only 10% of medical students had any
courses on how to care for dying patients.
• Practicing non-abandonment is tough when we don’t
know what to do.
• Know the signs and symptoms of dying and means to
treat them.
• Address fears, anticipate problems
• Sir William Osler: To cure sometimes, to alleviate
often, to comfort always.
“
“
35. Physiology of dying with cancer
• Cancer Cachexia/Anorexia
• Metabolic demands of cancer outpace that of the body
• Malnutrition: protein and fat depletion
• Loss of intravascular oncotic (osmotic) pressure due to low
albumin and other proteins
• “third spacing” of fluid to abdomen, lungs, subcutaneous
tissue
How does this differ from starvation?
36. Physiology of dying
• Decreased perfusion of brain
• Increased fatigue, somnolence
• Poor control of bowel and bladder
• Change in respiratory pattern (late)
• Decreased reflexes, including gag and
swallow – leads to pooling of saliva in back
of throat
• Decreased cardiac output
• Poor peripheral perfusion: skin breakdown
• Decreased perfusion of the kidneys (low
intravascular volume/pressure, low cardiac
output) leads to pre-renal azotemia
Signs/Symptoms
• Decreased
energy
• Increased sleep
• Respiratory
pattern changes
• “Terminal
secretions”
• Skin breakdown
• Peripheral
“mottling”
38. What signs/symptoms might she experience?
• Dolores returns
• she is now pancytopenic
due to bone marrow
involvement
• plts now 5,000/mcl,
• Hct 12%,
• WBC 2,000/mcl
Pan = all
Cyto = cell (usually referring to blood cells)
Penia = poverty
39. Where could she bleed?
• Brain
• Seizures, brain stem herniation
• Mucosa
• Nose bleeds, vaginal bleeds
• Lungs
• Dyspnea, hemoptysis
• GI tract
• Hematemesis, aspiration of blood,
bloody stool
• Retroperitoneal
• Back pain
What to do once you can no
longer transfuse blood? – Be
prepared
• For bleeds you can see:
dark blue towels, surgicel
or topical thrombin for
nose/mucosa
• Benzodiazepam for
seizures
• Opioid and benzo of
phenobarbitol for
hemoptysis, pain, etc.
42. Summary
• Most physicians practice Palliative Care every day
• Palliative care includes any care that enhances quality of
life (QOL) – regardless of its effect on longevity (it may
prolong life!)
• Prognostication is hard, but important. It helps patients
plan, achieve goals that they can reach.
• Palliative care can help patients at any stage of a serious
illness, while hospice is available for patients whose
prognosis is on average 6 months.
43. How to learn more
• EPEC (Education on Palliative & End-of-Life Care)
• Lois Green Learning Community
www.loisgreenlearningcommunity.org
• Get Palliative: www.getpalliativecare.org
• Pallimed Connect
Editor's Notes
My story:
This is April. I met her in my clinic in Billings. She first came to me for symptom management of her metastatic breast cancer. She also wanted to know what to eat, how to keep her function high. She was curious about our “Hope for Tomorrow” program for cancer patients. She and her husband joined – and participated in yoga, cooking class, groups support with mindfulness. This picture was taken 6 weeks before she died.
1- my patients found me. They wanted someone to listen, to manage their symptoms while someone else battled their illness, someone to help make plan “b” and to address their whole person.
2- I realized I was not as good at managing symptoms for patients as I thought I was. I thought Zofran was the be-all-and-end-all for nausea. I was wrong. I thought opioids were taught in residency. I was wrong. I thought at end of life, all meds, except morphine and ativan were given, generally speaking. I thought I knew how to tell who was dying.
3- I liked tending to the seriously ill. I was intrigued and curious about their ability to live so very fully. To find joy. To talk about difficult things and to find meaning. I often found them to be more alive than many. They showed me what hope really meant.
Everybody dies.
Cancer continues to be one of the leading causes of death.
Good symptom management, coordination of care and help patients live better and longer.
The obligation of the physician is to alleviate suffering.
I used to think that this was the model. We “treat” and then we help people die peacefully. I was wrong.
It is more like this… but I still don’t fully agree with this picture. After all – it is usually symptoms (except when there are screens) that bring our patients to us: dyspnea, nausea, pain… But anyway, curative and palliative therapies tend to work hand in hand. You do this every day, and better than most.
The paradigm of palliative care is to approach the person from a multi-dimensional model. Biopsychosocialspiritual was the way I learned it in medical school. Mind-body-spirit might be the way integrative medicine physicians call it. Good care, is another name. Most of us tend to 1-6 with our patients all the time. Even in palliative care, 7 and 8 are often not in the mix.
Nurse with metastatic breast ca – loves to golf and to work 12 hour shifts.
Hip pain was limiting her activity, however. How to respond?
Intrathecal pump – coordinated between neurosurgery, anesthesia, and palliative care
LL is a 57 yo woman with metastatic pancreatic cancer, diagnosed 5 years ago.
She now presents to hospital with:
Pain (rectal)
Breathlessness (pleural effusion and pericardial effusion)
Anorexia, weight loss
Fatigue
Her goals have always been to live as long as possible, to see her children grow, and in the words of USC, to “fight on!”
Pain: Opioids, steroids, plus: nerve block – impar or sub-gastric ganglion.
Dyspnea: Opioids, chlorpromazine, plus: thoracentesis, pericardial window
We want to offer hope… so how can we?
Story: 21 year old, dying of adenocarcinoma – Crohn’s – bowel obstruction
After he was told that the cancer was found everywhere, there there was no more curative treatment available…
He asked:
Will I have to stay in the hospital or can I get home to see my dog? – He had a 4 month old golden retriever. He didn’t want to see her in hospital – just at home.
He is at home now. His brother brought him his golden retriever home. She now visits daily – when he is up for it.
He asked his hospice nurse: Will I see my best friend before I die? Where is she? In Germany. Well, we shall see then.
They found an agency to help. She flew home 3 days later to spend time with him.
I asked him if he had any questions… He asked:
When will the bad pain start again? – I answered, If I do my job well, if the hospice nurses do theirs well, it will never start again.
Everybody dies.
Cancer continues to be one of the leading causes of death.
Good symptom management, coordination of care and help patients live better and longer.
The obligation of the physician is to alleviate suffering.
You can help them secure their hopes… for how they wish to be cared for at the end of life…
And avoid what most of us will end up facing
Everybody dies.
Cancer continues to be one of the leading causes of death.
Good symptom management, coordination of care and help patients live better and longer.
The obligation of the physician is to alleviate suffering.
Everybody dies.
Cancer continues to be one of the leading causes of death.
Good symptom management, coordination of care and help patients live better and longer.
The obligation of the physician is to alleviate suffering.
Help our way… Engage with grace – the one slide project – promoted over Thanksgiving
National healthcare decisions day – In April – this year, this weekend. Perhaps we could coordinate something for next year?
Everybody dies.
Cancer continues to be one of the leading causes of death.
Good symptom management, coordination of care and help patients live better and longer.
The obligation of the physician is to alleviate suffering.