Transcript 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
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
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
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
Disease process
Immobility
Anorexia
Insufficient fluid and dietary intake
Hospital environment
Drug therapy in particular pain killers
How Can It Be Prevented
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
Lactulose
Senna
Movicol
Suppositories/Enemas