Palliative and End of Life Care

padding and/ or occlusive dressings for high-risk areas. Patients should be repositioned ideally every 2 hours.

• hypoalbuminemia which leads to decreased oncotic pressure.
• Some pts may have lymphatic or venous obstruction from compression by a primary or metastatic tumor or postsurgical changes.

• Opioids! Low-dose tx with careful titration is safe and effective.
• Axiolytics (short acting benzo such as Xanax) also effective.

• Constipation: Tx w/ stimulant (bisacodyl) or osmotic (lactulose) laxatives
• Sedation: Tx change meds or route of admin. Psychostimulants (methyphenidate-Ritalin). Peristent sedation with inadequately releived pain implies need for adjuvant analgesics.
• Nausea and vomiting: tolerance often develops, antiemetics(promethazine, metoclopramide)
• Respiratory depression: appropriate titration by pain response and careful monitoring of the patient's level of alertness.

presumes normally functioning pain receptors and nerves. Responds well to opiates.

presumes abnormal function of either the peripher or central nervous system. May require opiates and adjuvant analgesics. (corticosteroids-pain caused by nerve compression, edema, acute neuropathic pain, and metastatic bone lesions. TCA's or anticonvulsants particularly gabapentin for neuropathic pain.)