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What do you do if a patient's family says the patient doesn't need to know?
Full and clear disclosure had both ethical and practical dimensions. You need to tell the patient no matter what.
Based on: Truth, trust and autonomy. Patient needs to know things.
Explain to family that we're not in the business of taking away hope, i understand why you don't want me to say, but say we cannot lie to a patient legally.
What are the limits to autonomy?
TO provide treatment to a patient that is illegal, unethical or excessively brutal
What are the relative strengths of codeine, oxycodone, morphine and hydromorphone. Assume that morphine is set at '1'.
Codeine is weakest
Oxycodone is 1.5 morphine
Hydromorphone is 5x
What is short-term acting oxycodone known as? What is oxycontin?
Endone. Oxycontin is time release oxycodone
What are the problems with opioids?
Constipation (give laxative as adjuvant)
What do you need to do for the patient in the terminal phase?
1. Comfortable bed, air mattress
2. Cease unnecessary medication
3. If patient is not swallowing use other means of giving medications
4. Relieve pain
5. Releif agitation/restlessness (Midazolam)
6. Mouth care (water spray)
7. Indwelling catheter
8. Relieve terminal secretions
What do we do with nutirition and fluids in the dying patient?
If excessive weight loss in advanced malignancy, this is often due to cancer and not starvation. Nasogastric tube will do no good in this case, and we must be careful of aspiration.
Fluids: Keep the mouth moist to relieve thirst. IV fluids may simply drown the patient and oral fluids may casue aspiration
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