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    Leopando Hospice-Palliative3

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    Judy Ignacio Eclarino
    The document discusses symptom control in palliative and terminal care for terminally ill patients. It describes common physical symptoms seen in the last 48 hours of life, including noisy breathing, pain, restlessness, and dyspnea. It provides strategies for managing these symptoms through non-pharmacological and pharmacological interventions. Effective symptom control is important for improving quality of life for terminally ill patients and providing comfort in their final hours. The goals of palliative care include relieving patient distress through comprehensive assessment, treatment of correctable issues, education of patients and families, and pain management.

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    Leopando Hospice-Palliative3

    Uploaded by

    Judy Ignacio Eclarino
    166 views2 pages
    The document discusses symptom control in palliative and terminal care for terminally ill patients. It describes common physical symptoms seen in the last 48 hours of life, including noisy breathing, pain, restlessness, and dyspnea. It provides strategies for managing these symptoms through non-pharmacological and pharmacological interventions. Effective symptom control is important for improving quality of life for terminally ill patients and providing comfort in their final hours. The goals of palliative care include relieving patient distress through comprehensive assessment, treatment of correctable issues, education of patients and families, and pain management.

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    LEOPANDO_HOSPICE-PALLIATIVE3

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    The document discusses symptom control in palliative and terminal care for terminally ill patients. It describes common physical symptoms seen in the last 48 hours of life, including noisy breathing, pain, restlessness, and dyspnea. It provides strategies for managing these symptoms through non-pharmacological and pharmacological interventions. Effective symptom control is important for improving quality of life for terminally ill patients and providing comfort in their final hours. The goals of palliative care include relieving patient distress through comprehensive assessment, treatment of correctable issues, education of patients and families, and pain management.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    166 views2 pages

    Leopando Hospice-Palliative3

    Uploaded by

    Judy Ignacio Eclarino
    The document discusses symptom control in palliative and terminal care for terminally ill patients. It describes common physical symptoms seen in the last 48 hours of life, including noisy breathing, pain, restlessness, and dyspnea. It provides strategies for managing these symptoms through non-pharmacological and pharmacological interventions. Effective symptom control is important for improving quality of life for terminally ill patients and providing comfort in their final hours. The goals of palliative care include relieving patient distress through comprehensive assessment, treatment of correctable issues, education of patients and families, and pain management.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 2

    TOPIC: TERMINALLY ILL: HOSPICE, PALLIATIVE AND SUPPORTIVE CARE

    SYMPTOM CONTROL IN PALLIATIVE AND


    TERMINAL CARE
    o Side effects
    INTRODUCTION
     The goals of palliative care include relief of o New pains -pains should not be automatically
    the patient's biological and psychosocial attributed to a pre-existing ailment as it may
    distress, as well as offering a support arise from disease progression, a treatable
    system to help the family cope acute problem, or a side effect of treatment.
     most common physical symptoms and
    signs seen during the last 48 hours of life of Dyspnea
    a terminally-ill patient  must first be differentiated from terminal
     include noisy breathing, urinary dysfunction, dyspnea
    pain, restlessness and dyspnea, nausea and  Adequate history taking, physical examination,
    vomiting, sweating, jerking, and confusion and appropriate investigations will identify the
    cause of abnormalities and acute changes which
    SYMPTOMS DURING THE FINAL 48 HOURS can still be treated by corrective therapy
     Non-drug treatment
    o Maximizing functional ability
    NOISY AND MOIST BREATHING
    o encourage the patient to explore his/her
    Respiratory secretions perceptions of his/her condition
     very distressful both to the patient and to the o maximize feeling of control
    family
    o avoid negative thoughts and ideas
     41 %-56% incidence of this symptom during the
    terminal phase of an illness
     Drug treatment
     d/t either the excessive production or inadequate
    o Bronchodilators
    clearance due to poor cough or swallow reflex
    o Four Main Management Strategies:  Beta-2 agonists such as salbutamol
    alleviates the breathlessness of most
    o Reassuring the patient and carers
    cancer patients despite their unaltered
    o Positioning:
    ventilatory indices
     more laterally or uprightly improves the o Morphine
    drainage of secretions
     reduces ventilatory response to
    o Suctioning
    hypercapnia, hypoxia, and exercise
    o Pharmacologic management  Benefits patients who are breathless at rest
     aims to dilate the airways and decrease than those who are breathless upon
    salivary and bronchial secretions exerting physical effort
     Atropine 0.4 mg SC q 2-4 hours PRN or 2 o Anxiolytics
    mg via nebulizer q 2-4 hours PRN o Steroids
    Pain  particularly good for dyspnea associated
     four dimensions: physical, social, psychological, with pulmonary metastases and
    and spiritual lymphangitis carcinomatosis
     Even if the patient is nearing death, it is still
    important to address this symptom Restlessness and Agitation
     occurrence of restlessness in the last hours of a
    o Breakthrough pain -intermittent patient's life may have multiple causes, none of
    exacerbations of pain is managed by which may be obvious
    supplementing morphine with the short acting  specific treatment is almost impossible
    opioid at 116 the 24-hour morphine dosage.  overlaps but is not necessarily identical to
    agitated delirium and terminal anguish
    o Incident pain -pain related to a specific
     The diagnosis of terminal agitation assumes that
    activity is addressed by administering a short- reversible conditions are excluded or that
    acting opioid 15-20 minutes before an patients fail to respond to treatment
    anticipated activity
     physicians should provide verbal and tactile
    reassurance, instruct family members to hold the
    o End of dose failure -pain exacerbated
    patient's hand, and speak quietly to the patient
    predictably before the next scheduled dose of
    morphine is addressed by increasing the
    CONCLUSION
    dosage of controlled-release morphine or
    decreasing dosing interval of the same drug. Basic approach:
    (1) gaining knowledge of the pain's cause

    1
    Reference: TEXTBOOK OF FAMILY MEDICINE, Leopando, et. Al.
    Prepared by: PGI Judy Anne I. Eclarino
    TOPIC: TERMINALLY ILL: HOSPICE, PALLIATIVE AND SUPPORTIVE CARE

    (2) making careful clinical assessments and


    investigations
    (3) maintaining good communication with patient and
    the family
    (4) providing treatment appropriate to needs of each
    patient

     Pain management should be conceptualized as


    a method of alleviating the patient's distress in
    addition to the recommended pharmacologic
    interventions
     The education and involvement of the patient
    and family are the most crucial factors in the
    successful management of pain
     Good symptom control will not only improve the
    patient's quality of life, but also provide
    reassurance to patients and families sharing
    their final hours together
     importance of understanding the symptom
    spectrum, its transitions, and establishing what
    is and what is not correctable

    2
    Reference: TEXTBOOK OF FAMILY MEDICINE, Leopando, et. Al.
    Prepared by: PGI Judy Anne I. Eclarino

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