Symptom Control

Managing Physical Symptoms

There are many potential physical symptoms related to life-threatening illness and the side effects of treatment. The following are effective ways of managing some of the more common problems. You will probably not experience all of these, but you should be aware of helpful ways to manage them if they occur. Please be sure to notify your nurse about physical symptoms you are experiencing.

Pain

Pain is both a physical sensation and an emotional experience.  We want to help you with pain management so together we can work toward maximizing your comfort as much as possible.  Having a life-limiting illness does not necessarily mean you will experience pain.  If you do experience pain, you can be confident that medications and other interventions are available to ease the pain. 

Information About Pain

Anxiety, tension & pain

Anxiety, tension and depression can add to your pain. They do not necessarily cause pain, but they can compound the pain experience.  One of the major benefits of achieving pain relief is that anxiety is also reduced.

Basic principles of pain management
Concerns about medications

Types of Pain Medications

Non-opioids

Non-opioids are pain medications which are used to treat mild or moderate pain.  Two well-known non-opioids are aspirin and acetaminophen.  Both of these drugs can be very effective for many types of pain.  They may be all you need to find relief, or you may need to take them along with another medication.

There are other non-opioid drugs which are helpful in the relief of pain.  These include medications to treat depression, muscle tension, anxiety, inflammation and others.  Whenever you receive a prescription for such a medication, your Hospice nurse will discuss its purpose, side effects and actions with you.

Opioids

More Information

What to Remember
  • Pain medication for chronic pain needs to be taken at regular intervals. The hospice nurse will help you establish the best times to use the medication.
  • Pain medication can be taken before the patient experiences pain.
  • Record the time you take your pain medication.
  • All opioids need a written prescription signed by the doctor to be refilled.
  • Opioids are likely to have a constipating effect on the bowels.
  • Opioids often cause the patient to become sleepy, but as the body adjusts to the narcotic the sleepiness should diminish.
  • Non-opioids such as ibuprofen should be taken with food if possible.
  • Do not crush long-acting narcotic pills.  If the patient is unable to swallow, tell the hospice nurse.  A different route or medication may be indicated.
Call the hospice nurse immediately if:

Nausea

Nausea means being sick to the stomach and vomiting means throwing up.  Nausea and vomiting can happen even when a person is not near food or thinking about food.  Some common reasons for nausea and vomiting are radiation or chemotherapy treatments, disease process or cooking smells.  Sometimes diseases themselves may cause nausea and vomiting.

How the Help

  • If the nausea occurs only between meals, give frequent small meals, snacks at bedtime and leave food within easy reach.

  • Seek out taste preferences; many patients develop distaste for red meat and broths. Substitute other protein sources.  Avoid fried and spicy foods.

  • Serve food cold or at room temperature to decrease its smell and taste.

  • Offer clear liquids (ginger ale, Jell-O, tea, popsicles, etc.)

  • Have the patient rest comfortably in a quiet environment.

  • Provide distraction such as soft music or favorite television show; stay and keep the person company.

  • Provide good mouth care.

  • Give appropriate medication to prevent nausea, if ordered.

Breathing

Breathing difficulty occurs when not enough oxygen is delivered to the body.  Either the lungs cannot breathe in enough air, or they cannot deliver enough oxygen to the bloodstream.  A number of different problems can cause this difficulty including chronic lung disorders, airway obstruction, pain, stress or anxiety, or fluid in the lungs.  You may see breathing changes as your loved one’s disease progresses.

Remember:

  • Be calm and reassuring.
  • Have the person sit up. Occasionally leaning forward helps with difficulty in breathing.  This position will help the lungs operate most efficiently.
  • Raise the head of the bed or place more pillows behind the back.
  • Avoid having the person lie flat.
  • Fresh air or a fan on low setting may be comforting.

Call the hospice nurse if:

  • The patient complains of difficulty breathing or chest pain.
  • The patient coughs up thick yellow, green or bloody sputum.
  • The patient’s skin is pale or blue or it feels cold and clammy.

Your hospice nurse will continually assess the patient’s breathing.  If breathing problems exist, the nurse will discuss the possible need for additional medication or oxygen.  If oxygen is needed, the nurse will order the needed equipment.

As the patient becomes weaker, clearing the throat may become more difficult and secretions may collect in the airway.  If secretions can’t be removed by coughing, the nurse will discuss various means of dealing with excessive secretions.

Anxiety, Fear and Depression

Some degree of anxiety, fear and depression can occur for persons coping with a serious illness.  These feelings are normal.

For the patient, feelings of anxiety, fear and depression can be due to loss of family role, loss of control over events of everyday life, changes in body image, fear of uncontrollable suffering and pain, fear of the unknown, and fear of death.

Family members may experience these feelings because of the loss of their loved one, anger at why this person has to die, fear of the patient’s death, and frustration at not being able to “do enough,” or stress due to increased responsibility at home.

If you or someone in your family needs support in dealing with anxiety, fear and depression, you may want to tell a hospice worker.  The hospice care team knows many ways of helping people develop their own coping abilities.

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