| Symptom |
Treatment Possibilities |
Shortness of Breath /
Dyspnea |
- 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.
|
| Fatigue |
- 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.
|
| Dry Mouth |
- 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.
|
| Appetite |
- 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.
|
| Weight Loss |
- 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.
|
| Pressure Ulcers |
- 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.
|
| Anxiety |
- 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.
|
| Depression |
- 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).
This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.