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Hospice - Coggle Diagram

- - - - Levedopa
        
        Fewest adverse effects in short erm
        
        Associated with development of motor fluctuations (wearing off) and dyskinesias
        
        Difficult to resolve fluctuations / dyskinesia
      - MAOI
      - COMT inhibitors
      - Melatonin
        
        Treats sleep disturbance
    - - Hypophonia / dysphonis
      - Dysphagia
      - Sialorrhoea - excessive saliva
    - - Usual PD medication regime asap
      - Treat underlying infx / electrolyte disturbances / constipations / dehydration
      - Recognise delirium - 4A
      - Review recent changes to meds
      - No Dopamine anagonists
        stemetil
        Metochlopromide
        Haloperidol
- - - - Class
        
        Typical antipsychotic
      - MOA
        
        Antagonist for
        D2
        5HT2A
        alpha 1
        alpha 2
        H1
        Antimuscarinic
      - Indications in Palliative care
        
        Agitation
        
        Second line anti-emetic
        
        Pain
      - Pharmacokinetics
        
        PO bioavailability 20-50%
        
        Onset 30 min
        
        DOA 12-24h
      - Adverse effects
        
        Dry mouth
        
        Sedation
        
        Hypothermia
        
        Hypotension
        
        QT alterations
        
        Extrapyramidal effects
      - Contraindications / Cautions
        
        Dementia
        
        Cardiac disease
        
        Parkinsonism
        
        Postural hypotension
  - - - Inflammatory and allergic disorders
      - Skin conditions
      - Ulcerative colitis
      - Arthristi
      - Lupus
      - Psoriasis
      - COPD / Bronchial asthma
      - Dexamethasone suppression test
    - - Corticosteroid
    - - PO:open_mouth:
      - IV :syringe:
    - - Cortisol analogue
      - Agonist of the gluccocorticoid receptor (GR) (highly selective for GR over MC)
      - Drug-receptor complex translocates to nucleus
      - Acts as transcription factor for target gene expression
      - Phospholipase a2 inhibitory proteins decrease synthesis of prostaglandins / leukotrienes
      - Inhibits inflammation through dowregulation of pro-inflammatory molecules
    - - Fungal infx
      - Chicken pox
      - Measles
      - Caution - Dosage Change
        
        Illness
        
        Surgery
        
        Stress
        
        Medical emergency
        
        Hepatic impairment
      - Live virus vaccines
      - Ocular herpes simplex
    - - Muscle tightness, weakness or limp feeling :muscle:
      - Blurred vision, tunnel vision, eye pain :eye:
      - Shortness of breath :wind_blowing_face:
      - Weight gain :weight_lifter:
      - Hypokalaemia :banana:
      - Increased Blood pressure :tent:
      - Cushings syndrome
    - - Antibiotics / antifungals
      - Birth control pills / HRT
      - Insulin + oral diabetes meds
      - Warfarin
      - NSAIDs
    - - Symptom control of anorexia in Palliative care : 2-4mg
      - Dysphagia due to obstruction in palliative care: 8mg
      - Dyspnoea palliative care: 4-8mg
      - Nausea / vomiting palliative care: 8-16mg
      - Equivalent Doses
        
        1.5mg Dex
        10mg Prednisone
        40mg Hydrocortisone
        
        1mg Dex IV or PO
        6.7mg Presnisone PO
        27.7mg Hydrocortisone IV or PO
  - - - Tricyclic Antidepressant
    - - SERT and NET inhibitors - analgesic action through α2
      - Blocks voltage gated NA+ channels
      - Reduces pain transmission from site of nerve injury
    - - Major depressive disorder
      - Neuropathic pain
      - Fibromyalgia
      - Migraine
      - Tension headaches
    - - Dry mouth
      - Drowsiness
      - Dizziness
      - Contsipation
      - Weight gain
    - - MI
      - Arrhythmias / heart block
      - Coronary artery disease
      - Porpyria
      - Severe liver disease - cirrhosis
      - MOAI
      - Caution
        
        Epilepsy
        
        Impaired hepatic function
    - - Bioavailability 50%
      - Metabolism - CYP2C19 and CYP2D6
      - PO
- - - - Pain
      - Infection
      - Nutrition
      - Constipation
      - Hydration
      - Medication
      - Environmental changes
  - - - Clinical features
        
        Agitation
        
        Delusions
        
        Hallucinations
        
        Wandering
        
        Aggression
    - - Clinical Features
        
        Lethargy
        
        Slowness with everyday tasks
        
        Excessive sleeping
        
        Inattention
  - - - Age >65
      - Previous episodes of delerium / confiremed hx of demetia
      - Current hip fracture
      - Severe concurrent illness
    - - Acute onset and fluctuating course and
      - Inattention and either
      - Disorganised thinking or
      - Altered level of conciousness
    - - What is your age (+/- 1 year)
      - What is the time now +/- 1 hour)
      - What year is it
      - Memories an address
      - When is your birthday
      - When did WW2 begin
      - What is the Queens name
      - Can you recognise 2 people
      - Can you count backward rom 20-1
      - Can you recall the address I Just gave you
    - - Congnitive Screening
- - - - Malaise
      - Agitation
      - Lethargy
      - Stupor¬
    - - Cool skin
      - Cyanosis :large_blue_circle:
      - Increased capillary refill
      - Mottling
- - - - Soluble
        
        Softens stoll
        
        Oats
        Barley
        Fruit
        Pulses
      - Insoluble
        
        Adds bulk (weight) to stool
        
        Wholegrain bread
        Cereal
        Pasta
        Brown rice
        Skins of fruit / veg
      - 25g per day
    - - 30min 5 days a week
  - - - Frequency, nature, consistency of stool
      - Pain on defecation
      - Straining or discomfort
      - Recent change in bowel habit
      - Constipation alternating with diarrhoea
      - Associated blood / mucus
      - Tenesmus (sensation of incomplete evacuation)
      - Abdominal pain
      - Systemic features
- - - - Slurred speech
      - Partial obstruction - snoring / noisy breathing
      - Beware of vomiting
    - - Respiratory depression
      - Hypoxia
      - Resp arrest
      - Low Resp rate <12 b/m
    - - Bradycardia
      - Vasodilation and hypotension
    - - Miosis
    - - Evidence of recreation drug use / drug paraphernalia
- - - - Associations
        
        Stress
        
        Depression
        
        Alcohol
        
        Skipping meals
        
        Dehydration
      - Features
        
        Mild ache or pressure in a band like pattern around the head
        
        Develop and resolve gradually
        
        Do not produce visual changes
      - Management
        
        Reassurance
        
        Simple analgesia
        
        Paracetamol
        
        Ibprofen
        
        Chronic / Frequent tension headaches
        
        Amitriptyline
      - Site
        
        Bilateral in a band like pattern around the head
      - Character
        
        Pressing / tightening
      - Severity
        
        Mild / moderate
        Not disabling
      - Timing
        
        30min-7days
    - - Site
        
        Unilateral (often bilateral)
      - Character
        
        Pulsatile / throbbing
      - Severity
        
        Moderate to severe
        Disabling
      - Associations
        
        Nausea
        
        Vomiting
        
        Photophobia
        
        Phonophobia
      - Timing
        
        Hours - days
        Usually 4-72 hrs
    - - Site
        
        Always unilateral
      - Character
        
        Excruciating
        
        Stabbing
        
        Burning
      - Severity
        
        Very severe
      - Associated symptoms
        
        Restlessness
        
        No aggravation on phy activity
        
        Ipsilateral to pain there may be:
        
        Conjuctval injection
        
        Lacrimation
        
        Nasal congestion
        
        Rhinorrhoea
        Ptosis / miois
      - Timing
        
        15min - 3hrs
    - - Similar presentation to tension headache but with a clear cause
      - Aetiology
        
        Infections
        eg VRTI
        
        Obstructive sleep apnoea
        
        Pre-eclampsia
        
        Head injury
        
        Carbon monoxide poisoning
    - - Inflammation of the paranasal sinuses in the face
      - Pain and pressure following recent viral upper resp infx
        
        May be tenderness and swelling on palpation
        
        Most resolve within 2-3 weeks
      - Management
        
        Prolonged cases
        
        Steroid spray
        
        Antiobiotics - Phenoxymethylpenicillin 1st line
    - - Aetiology
        
        Frequent analgesia use
      - Features
        
        Non specific
    - - Aetiology
        
        Low Oestrogen
        
        May occur 2 days before and 3 days during menstrual period
        
        May occur in early pregnancy
      - Features
        
        Similar to migraine
        
        Unilateral pulsatile headache
        
        Associated with nausea
      - Management
        
        Triptans
        
        NSAIDs
  - - - Meningitis
        Encephalitis
        Brain abscess
    - - Haemorrhage
        Tumour
    - - Tumours
        Giant cell arteritis
        Glaucoma
    - - Subarachnoid haemorrhage
    - - Raised intracranial pressure
    - - Raised intracranial pressure
    - - Raised intracranial pressure
    - - Intracranial haemorrhage
    - - Brain metastasis
    - - Pre-eclampsia
  - - - Suggests raised intracranial pressure
        
        Tumour
        
        Benging
        
        Intracranial bleed
- - - - Unknown
    - - Swelling in fingers
      - Intermittent coolness and blue discoloration of fingers - Raynaud's phenomenon
      - Joints freezing in permanent usually flexed positions
      - Damage to GI system, lungs, heart and kidneys may develop
      - Antibodies in the blood characteristic of an autoimmune disorder
      - Skin changes - stiffening , hardening, tightening
      - Digestive Problems - swallowing difficulties, heartburn
      - Joint or muscle pain or stiffness
    - - Over production of collagen and other proteins in various tissues
    - - Limited systemic sclerosis (CREST syndrome)
      - Diffuse systemic sclerosis
      - Systemic sclerosis without scleroderma
    - - Pain / Swollen joints
        
        NSAIDS
      - Raynaud's
        
        Iloprost
      - Heartbrun / swallowing