The Common Sense Guide to Improving Palliative Care > Assuring Comfort > 5.11 Tools and Resources: A Starter Guide to Symptom-Specific Treatment

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Tools and Resources: A Starter Guide to Symptom-Specific Treatment

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.

What Are the Best Symptom-Management Tools That I Can Use to Assess My Patients?

There are many instruments available for measurement of multiple symptoms (MSAS, Rotterdam Symptom Checklist, Symptom Distress Scale).

What Are Some Good Websites for Symptom-Management Resources?

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