European Certificate in Essential Palliative Care - Chapter Five
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Questions and Answers

What is the primary purpose of relaxation techniques in managing anxiety?

  • To eliminate all anxious thoughts immediately
  • To ensure a longer duration of sleep
  • To help individuals focus away from anxiety and relax (correct)
  • To promote physical exercise for overall health

Which pharmacological treatment is noted for its potential issues with long-term use?

  • Tricyclic antidepressants
  • Benzodiazepines (correct)
  • Progressive muscular relaxation
  • Guided imagery techniques

Which technique involves visualizing calming scenarios to address anxiety?

  • Cognitive restructuring
  • Guided imagery and visualization (correct)
  • Progressive muscular relaxation
  • Behavioral therapy

What aspect should be considered when choosing the most effective treatment for anxiety?

<p>Severity of anxiety and personal preferences (A)</p> Signup and view all the answers

Which of the following statements about benzodiazepines is true?

<p>They can help break the cycle of anxiety in the short term. (C)</p> Signup and view all the answers

Which muscle relaxation technique involves both tensing and relaxing different muscle groups?

<p>Progressive muscular relaxation (A)</p> Signup and view all the answers

Which antipsychotic medications are noted for causing fewer extrapyramidal side effects compared to haloperidol?

<p>Risperidone, olanzapine, or quetiapine (B)</p> Signup and view all the answers

What is a common short-term treatment for extreme panic or anxiety?

<p>Lorazepam (B)</p> Signup and view all the answers

What is the recommended approach if anxiety is the overriding symptom in delirium management?

<p>Administer Diazepam 2 - 5mg TDS PO or PR (A)</p> Signup and view all the answers

What might happen if benzodiazepines accumulate in the system?

<p>They can cause sedation due to their long half-life (D)</p> Signup and view all the answers

What distinguishes delirium from dementia during an assessment?

<p>Delirium has an acute onset with identifiable changes, while dementia does not. (C)</p> Signup and view all the answers

In what situation should atypical antipsychotics be avoided?

<p>When a patient has a history of cerebrovascular thrombosis (D)</p> Signup and view all the answers

What is one non-pharmacological intervention recommended for managing delirium?

<p>Ensuring patients have their glasses and hearing aids (D)</p> Signup and view all the answers

Which medication would be appropriate for managing restlessness and delirium in a terminal phase patient?

<p>Midazolam 5 - 100mg / 24 hours CSCI (C)</p> Signup and view all the answers

Which of the following statements about the effects of delirium and dementia is incorrect?

<p>Delirium typically does not affect consciousness until late stages. (D)</p> Signup and view all the answers

Which symptom is primarily associated with dementia rather than delirium?

<p>Progressive memory loss, particularly for recent events (B)</p> Signup and view all the answers

What is the main approach for managing depression in patients with terminal illnesses?

<p>Emotional and social support with a multidisciplinary approach (A)</p> Signup and view all the answers

Which selective serotonin reuptake inhibitor (SSRI) is considered first-line treatment for depression according to the management guidelines?

<p>Sertraline 50mg once daily (B)</p> Signup and view all the answers

What potential risk is associated with patients taking SSRIs and NSAIDs?

<p>Higher likelihood of developing GI bleeds (D)</p> Signup and view all the answers

Which of the following statements about the pharmacological management of depression is correct?

<p>Fluoxetine should be monitored for agitation. (A)</p> Signup and view all the answers

Which assessment tool is useful for screening depression in patients suspected to have the condition?

<p>The Hospital Anxiety and Depression Scale (D)</p> Signup and view all the answers

What is a known side effect of tricyclic antidepressants that may impact patient safety?

<p>Hypotension (B)</p> Signup and view all the answers

What type of anxiety management strategies might also be effective for managing depression?

<p>Non-pharmacological interventions (D)</p> Signup and view all the answers

Which underlying factor is essential to consider when selecting pharmacological treatment for depression?

<p>Underlying disease (A)</p> Signup and view all the answers

Flashcards

Dementia and Parkinson's Disease

Conditions that may present with symptoms of depression.

Depression Screening Tools

Tools like the Hospital Anxiety and Depression Scale(HADS) and the Brief Edinburgh Depression Scale (BEDS) help identify possible depression.

Depression Management

Treating depression focuses on emotional and social support, addressing concerns, and a multi-disciplinary approach.

Non-Pharmacological Interventions

These methods, effective for anxiety, can also help treat depression without medication.

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Pharmacological Depression Management

Medication choice depends on the patient's profile, underlying conditions, preferences, and symptoms.

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SSRIs (Selective Serotonin Reuptake Inhibitors)

First-line treatment for depression, including sertraline and citalopram.

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SSRI Side Effects (GI Bleeds, Serotonin Syndrome)

SSRIs may cause gastrointestinal bleeding and serotonin syndrome; be cautious when used with other medications.

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Tricyclic Antidepressants (Side effects)

May take weeks to work and have side effects like hypotension and difficulties with urination.

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Anxiety Management

Methods to help people manage and reduce anxiety, ranging from talking therapy to relaxation techniques and medication.

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Relaxation Techniques

Methods to reduce both physical and mental anxiety, such as Guided Imagery and Progressive Muscle Relaxation.

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Guided Imagery

A relaxation technique where a person visualizes a peaceful scene to reduce anxiety.

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Progressive Muscle Relaxation

A relaxation technique involving tensing and releasing different muscle groups to reduce physical tension and anxiety.

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Benzodiazepines

Medication used to quickly manage anxiety, but not a long-term solution due to addiction potential.

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Diazepam

A benzodiazepine, used for short-term anxiety, it has a long half-life.

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Antidepressants for anxiety

Medication (e.g., tricyclic antidepressants like amitriptyline) used to treat generalized anxiety disorders.

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Stepped Approach to Anxiety Treatment

A treatment plan building up from basic therapies to more complex intervention strategies, depending on severity.

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Delirium vs. Dementia

Delirium is an acute, reversible condition affecting mental status, while dementia is a slow, chronic, progressive brain disorder.

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Delirium Symptoms

Characterized by impaired attention, fluctuating consciousness (lethargic to hyperalert), and variable memory effects.

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Delirium Causes

Often due to treatable medical conditions like infections, medications, or pain, unlike dementia which is caused by chronic disorders like Alzheimer's.

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Atypical Antipsychotics

Medications like risperidone, olanzapine, or quetiapine, offering fewer extrapyramidal side effects than haloperidol.

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Benzodiazepines

Medications like diazepam or midazolam used sparingly for anxiety associated with delirium, possibly in conjunction with antipsychotics.

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Non-Pharmacological Interventions

Strategies like ensuring access to glasses, hearing aids, and dentures, maintaining a calm environment, and reminding the patient of their surroundings to improve orientation and function.

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Agitated Depression Management

Amitriptyline 25mg at night, is a potential treatment for agitated depression.

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Terminal Phase Restlessness

Midazolam, Levomepromazine, therapies are administered continuously for 24 hours at continuous subcutaneous infusion (CSCI) in the terminal phase of restlessness/delirium.

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Study Notes

European Certificate in Essential Palliative Care - Chapter Five

  • This chapter focuses on the management of non-physical symptoms in palliative care.
  • Physical and non-physical symptoms are intertwined and holistic assessment is key.
  • Fatigue is a debilitating symptom that can be associated with deterioration in condition, treatment(chemotherapy/radiotherapy), low mood, or disease.

Fatigue

  • Fatigue is distinct from tiredness, which is often relieved by sleep.
  • Assessment of fatigue involves understanding its impact on daily life, factors worsening it, and what helps relieve it.
  • Contributing factors to fatigue include anxiety, depression, sleep disturbances, pain, fluid/electrolyte imbalance, anaemia, poor oral intake, cachexia, cardiac/respiratory disease, renal/hepatic disease, and hypothyroidism.
  • Management of fatigue involves a multi-faceted approach including early involvement of physical and occupational therapy, keeping a fatigue diary, encouraging energy conservation, optimizing nutrition and hydration, prioritizing activities, daytime naps, sleep hygiene, planning activities for energy peaks, encouraging appropriate exercise, relaxation techniques, and pacing/rest.

Anxiety

  • Anxiety, a common experience in life-limiting illnesses, can be a response to fears of death, loved ones' well-being, uncontrolled symptoms, and loss of independence.
  • Physical symptoms of anxiety include sleep disturbances, tremors, nausea, dry mouth, feeling clammy, fluttering stomach, palpitations, hyperventilation, pins and needles, breathlessness, anorexia, and headaches. Emotional symptoms include feelings of panic, emotional lability, fear, anger, low mood, and irritability. Behavioral symptoms include excessive alcohol/drug use, outbursts of anger, restlessness, and changes in sexual behavior.
  • Management involves relaxation techniques, guided imagery, and/or possibly pharmacological interventions.

Depression

  • Depression, with or without anxiety, is common and underreported among those with life-limiting illnesses.
  • Physical symptoms can overlap with the illness itself, and focus on psychological symptoms alongside physical assessment is critical.
  • Risk factors include a history of depression, lack of social support, isolation, chronic pain, advanced illness at diagnosis, and associated medical conditions like dementia or Parkinson's disease.
  • Management involves addressing, reversible factors, addressing emotional and social support, and encouraging expression of concerns, using a multi-disciplinary approach.

Delirium and Confusional States

  • Delirium is an acute, fluctuating state of disturbed consciousness, cognitive function, or perception, often developing over 1-2 days.
  • This state can be caused by medication interactions, infection, pain, constipation, or acute medical issues.
  • Factors that increase risk are advanced age, moving to a new environment (hospital/hospice), hearing loss, and visual impairment.
  • Management aims to treat the underlying cause while ensuring patient safety, with possible reliance on communication, safety measures, and potentially pharmacological intervention.

Spiritual Pain and Distress

  • Spiritual pain is a distinct symptom, not just related to religion, but to a person's sense of meaning and life's purpose and can arise as the person approaches the end of life.
  • Assessment involves open-ended conversation, non-judgmental listening, and using tools to assess and understand the beliefs and significance to the individual.

Sexual Issues and Intimacy

  • It is important to address sexual issues and intimacy, despite potential challenges from healthcare professionals.
  • A holistic and empathetic approach can create a safe space for these discussions, acknowledging the significance of sexuality and intimacy.
  • Issues that may impact sexual function include psychosocial concerns (anxiety and depression), physical limitations (fatigue and pain), side effects of medications, and emotional distress.

Conclusion

  • Non-physical symptoms are essential to address alongside physical symptoms.
  • This requires attention to detail in assessment and a multi-disciplinary approach.

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Description

This quiz covers Chapter Five of the European Certificate in Essential Palliative Care, focusing on the management of non-physical symptoms, specifically fatigue. Learn about the distinctions between fatigue and tiredness, contributing factors, and multi-faceted management approaches to improve patient care. Assess the holistic impact of these symptoms in palliative settings.

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