Podcast
Questions and Answers
What is the primary purpose of relaxation techniques in managing anxiety?
Which pharmacological treatment is noted for its potential issues with long-term use?
Which technique involves visualizing calming scenarios to address anxiety?
What aspect should be considered when choosing the most effective treatment for anxiety?
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Which of the following statements about benzodiazepines is true?
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Which muscle relaxation technique involves both tensing and relaxing different muscle groups?
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Which antipsychotic medications are noted for causing fewer extrapyramidal side effects compared to haloperidol?
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What is a common short-term treatment for extreme panic or anxiety?
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What is the recommended approach if anxiety is the overriding symptom in delirium management?
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What might happen if benzodiazepines accumulate in the system?
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What distinguishes delirium from dementia during an assessment?
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In what situation should atypical antipsychotics be avoided?
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What is one non-pharmacological intervention recommended for managing delirium?
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Which medication would be appropriate for managing restlessness and delirium in a terminal phase patient?
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Which of the following statements about the effects of delirium and dementia is incorrect?
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Which symptom is primarily associated with dementia rather than delirium?
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What is the main approach for managing depression in patients with terminal illnesses?
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Which selective serotonin reuptake inhibitor (SSRI) is considered first-line treatment for depression according to the management guidelines?
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What potential risk is associated with patients taking SSRIs and NSAIDs?
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Which of the following statements about the pharmacological management of depression is correct?
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Which assessment tool is useful for screening depression in patients suspected to have the condition?
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What is a known side effect of tricyclic antidepressants that may impact patient safety?
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What type of anxiety management strategies might also be effective for managing depression?
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Which underlying factor is essential to consider when selecting pharmacological treatment for depression?
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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.
