Download Pain

Managing Symptoms
in Palliative Care
Aims
 To gain an awareness of the most common
symptoms in patients with life limiting
diseases and why these occur
 To identify your role in supporting patients
and their families with these symptoms
 To understand how to promote patient
comfort and improve the quality of care
What are the most common
symptoms?
 Pain
 Anorexia/Cachexia
 Constipation
Pain
 ¾ of patients with cancer
 Common in heart, respiratory and renal
disease
 Neurological conditions, e.g. MS
 Arthritis/Rheumatoid disease
 Many other causes e.g. constipation.
headache
Factors that can make pain
worse
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Fear, worry, distress
Lack of knowledge
Poor communication
Other symptoms/illnesses
Social circumstances
Spiritual well-being
Movement/positioning
Factors that can make pain
better
 Information about condition and cause of
pain
 Time, listening, understanding, knowing
someone cares
 Analgesia/other interventions
 Support from and for family
 Other symptoms including social and
spiritual needs addressed
The key to effective
pain control is
thorough assessment
Assessment
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Where is/are the pain(s)?
What does the pain feel like?
Ask about each pain separately
What brings the pain on?
What makes it better?
Does your medicine help?
Pain Control
 Generally through medication
 Different types of medication e.g.
paracetemol, anti – inflammatory drugs,
morphine
 Different routes
 Benefits/ side effects
What is your role?
 Communication, i.e. listening, being there,
physical contact
 Reporting pain – where, description, score if
possible
 Adapting nursing care - reporting if analgesia has
helped
 Patient and family involvement
 Building trusting relationship
 Challenges/
Anorexia
 Decreased appetite often caused by disease
process
 Anorexia - Cachexia syndrome in cancer
 Alterations in normal break down of
carbohydrate, proteins and fats - Increased
energy expenditure leading to increased
weight loss
 Common source of distress for patients and
families
Causes of Anorexia
 Many causes
 Indigestion, difficulty swallowing, painful mouth,
nausea and vomiting, constipation, pain and
breathlessness
 Secondary to treatment e.g.
chemotherapy/radiotherapy, drug therapy.
 Anxiety/depression
 Blood abnormalities e.g. high calcium levels, low
sodium
 Hospital food/odours
Impact on Patient/Families
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Altered nutritional state – weight loss
Fatigue/Altered body image
Decreased energy/mobility
Social isolation
Low mood/depression
Frustration/despair for patients and families
Conflict
Your Role
 Maintain and where possible improve nutritional
state
 Try and identify why patient is anorexic/report
 Drug therapy e.g. Dexamethesone/Megace or
creative supplements may help
 Work as part of the multidisciplinary team
 Be observant/report any changes
 Support relatives not to talk about food all the time
 Appreciate that eating can be hard work and
gradual reduction of food is common as end of life
Constipation
 Extremely common in palliative care
 Major source of distress for patients and
families
 Usually avoidable
 Often linked to other symptoms
Causes Of Constipation
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Disease process
Immobility
Anorexia
Insufficient fluid and dietary intake
Hospital environment
Drug therapy in particular pain killers
How Can It Be Prevented
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Good basic nursing care.
Assess the patient – know their risk factors
Encourage fluids/diet/mobility
Monitor/chart bowel function as part of daily
nursing care
 Observe for signs that may indicate
constipation e.g. abdominal pain, agitation,
nausea, vomiting, anorexia
Drug Treatment of Constipation
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Lactulose
Senna
Movicol
Suppositories/Enemas