Palliative care medication in practice

Palliative care medication in practice

Instructions/Descriptions

Palliative care medication in practice

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The route of administration and other factors (such as lipid solubility of the drug, surface area available for absorption, as well as the concentration gradient) will affect the rate of absorption of drugs taken orally or subcutaneously, as illustrated in the earlier discussion about oral morphine and transdermal fentanyl.

Identify the medications that may be combined with diamorphine for administration in a syringe driver.

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Jane Adams Gastric cancer Case study

Jane Adams is a 42-year-old woman diagnosed with a gastric tumour three months ago. At the point of diagnosis, Jane has metastatic spread of the disease. Jane has been treated with chemotherapy to shrink the tumour, with the aim of reducing some of the gastric symptoms she has been suffering. On referral to the palliative care service, Jane is complaining of persistent pain in her epigastric/upper abdominal region, which is waking her at night and troubles her intermittently during the day. The pain is thought to be from the primary tumour. The pain is restricting Jane’s ability to mobilise and, as a result, Jane does not feel able to ‘get out and about’. Jane lives with her husband and her children, who are aged 14 and 12 Jane’s husband feels his wife’s reluctance to continue normal activities due to the pain is causing her to feel low and is impacting on their children, as Jane no longer takes them to school or collects them. Jane has been taking tramadol 100mg 3 times daily for pain relief. Initially this intervention was effective but now this only relieves the pain for 2 hours or less. Professional opinion is that Jane needs to commence on morphine sulphate for pain control. Jane continues to complain of feeling nauseated and has poor appetite; she finds that preparing food makes her symptoms of nausea worse.

On initial assessment of Jane, you note:

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• She guards her abdominal area at all times
• She frequently burps and hiccups
• She is underweight
• She tells you she feels sick all the time and cannot eat
• She complains of feeling weak and tired
• During the assessment Jane starts to cry and tells you she feels very down and fearful of the future
• When you examine Jane’s mouth you note the presence of oral
  

  Palliative care medication in practice

  

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