|Shortness of Breath /
- Change position.
- Use relaxation techniques.
- Improve airway circulation.
- Dispense medications: opioids, such as morphine; sedatives, such as benzodiazepines; oxygen; corticosteroids;or bronchodilators, as needed.
- Use a fan, which encourages the individual to feel that air is available.
- Unclutter the environment.
- Do not rush the patient, and allow for breaks for the patient to catch his or her breath during activities.
- Provide supplemental oxygen.
- Conserve energy.
- Improve sleep.
- Exercise, or provide physical therapy.
- Dispense medications: psychostimulants; low-dose corticosteroids (e.g., dexamethasone or prednisone); antidepressants; trial of erythropoietin for fatigue caused by anemia.
- Provide rest periods between activities.
- Drink lots of fluids, except in the active dying phase, when fluid intake might be detrimental.
- Maintain good oral hygiene.
- Provide humidified air.
- Suck on ice or vitamin C tablets.
- Chew sugarless gum.
- Use artificial saliva, provided in a spray form.
- Swab the mouth with cool water.
- Eat small, frequent meals.
- Eat high-calorie, high-protein foods, and take nutritional supplements.
- Obtain nutritional counseling.
- Trial of medication: corticosteroid, megestrol acetate, dronabinol, cyproheptadine, pentoxifylline.
- Protect the skin, provide for debility, try supplements, but accept weight loss as normal dying.
|Nausea and Vomiting
- Take antinausea medication.
- Snack on frequent light meals throughout the day.
- Avoid fried, spicy, or acidic foods.
- Maintain oral hygiene.
- Provide fresh air.
- Avoid strong odors.
- Provide rest and relaxation.
- Intake clear fluids.
- Keep skin dry and clean.
- Check skin daily for pressure sores and other skin irritations.
- Turn a bedridden person every few hours, alternating positions.
- Keep the heels off the bed.
- Encourage the patient to get out of bed as much as possible.
- Never leave the patient lying or sitting in wet clothes or bedding.
- Make sure the bedding is not wrinkled or irritating the patient's skin.
- Promote a balanced, nutritious diet that is high in protein.
- Do not open or break blisters.
- Put dry, clean gauze on any open areas until a clinician can assess and provide appropriate dressings.
- Alternate pressure pad or special pressure-reducing mattress and seating pads.
- Teach stress-management techniques, such as progressive relaxation, guided imagery, and hypnosis.
- Provide counseling.
- Encourage support from family, friends, spiritual leaders, and peers.
- Maintain control of pain, side effects from medication and other medical conditions, where possible.
- Trial of medication: benzodiazepines, other tranquilizers (such as the phenothiazines and haloperidol), antihistamines (e.g., hydroxyzine), antidepressants, opioids.
- Exercise, if able, including walking.
- Dispense antidepressant medication, including methylphenidate (when appropriate) for quick relief.
- Manage pain and other distressing symptoms.
- Provide counseling.
- Encourage support from spiritual leaders, family, friends, and peers found through support groups.
- Teach stress relief and pain management techniques, such as relaxation, guided imagery, and distraction.
|Adapted from www.stoppain.org. Used with permission.
There are many instruments available for measurement of multiple symptoms (MSAS, Rotterdam Symptom Checklist, Symptom Distress Scale).