The District Nurse requests a prescription for a syringe driver for a patient you assessed earlier in the day. The patient, who is in their late 70s, is dying from metastatic renal cancer. You recommend a 24-hour dose of 60mg of diamorphine. Please provide the correct wording for the prescription.
You receive a call from the Coroner’s officer regarding the sudden death of a patient you were treating. Upon reviewing your written report on the patient’s care, you are summoned to appear in person at the Coroner’s court to provide evidence, along with other healthcare professionals who also treated the patient. What is the purpose of this procedure?
A 50-year-old woman has metastatic breast cancer in her bones. Pain has been well controlled with modified-release morphine and she is still quite mobile. A palliative care nurse has given her a National Comprehensive Cancer Network (NCCN) Distress Thermometer for Patients. This is a visual analogue scale that records subjective distress on a scale of 0-10. She records 7-8 and most of this is recorded as being due to emotional issues (depression, nervousness, worry, loss of interest). She is assessed to have moderate depression with significant functional impairment. She declines psychological intervention, but would be happy to take medication.
Which of the following is the most appropriate medication?
A client is taking tramadol 100 mg qds. Despite this, they are experiencing inadequate pain relief. What is the equivalent 24-hour dosage of oral morphine?
You assess a 73-year-old man with metastatic bowel cancer who is in the final stage and has a syringe driver. Regrettably, he is experiencing intestinal obstruction and is distressed with bowel colic. Which medication should be included in the syringe driver?
A 70-year-old man with metastatic prostate cancer is experiencing increased pain and frequent vomiting while taking oral modified-release morphine sulphate 60mg bd. It has been decided to switch to subcutaneous administration. What is the appropriate dosage of morphine for a continuous subcutaneous infusion over a 24-hour period?
A syringe driver is ordered for a patient who is in the final stages of metastatic breast cancer. Which of the following medications is not compatible with dexamethasone, metoclopramide, and midazolam?
A 78-year-old male with multiple myeloma is currently suffering from sudden onset of back pain. He is taking 7.5mg morphine four times a day and 1g paracetamol four times a day as his regular oral analgesic medications. What is the appropriate dose of morphine for breakthrough pain in this case?
A senior gentleman with metastatic prostate cancer is being evaluated. He is presently managing his pain with MST 30 mg twice daily, but due to his inability to swallow medication, he has become lethargic. A syringe driver is being arranged. What would be the most suitable prescription?
A 72-year-old man who has recently undergone palliative radiotherapy for head and neck cancer visits the clinic complaining of constant diffuse mouth pain. Upon examination, there is widespread erythema with no visible focal lesions, ulceration, or candidiasis.
Apart from administering analgesics, what is the most suitable treatment?