1. Managing Symptoms in Palliative Care

2. 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

3. What are the most common symptoms?  Pain  Anorexia/Cachexia  Constipation

4. 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

5. Factors that can make pain worse  Fear, worry, distress  Lack of knowledge  Poor communication  Other symptoms/illnesses  Social circumstances  Spiritual well-being  Movement/positioning

6. 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

7. The key to effective pain control is thorough assessment

8. 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?

9. Pain Control  Generally through medication  Different types of medication e.g. paracetemol, anti – inflammatory drugs, morphine  Different routes  Benefits/ side effects

10. 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/

11. 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

12. 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

13. 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

14. 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

15. Constipation  Extremely common in palliative care  Major source of distress for patients and families  Usually avoidable  Often linked to other symptoms

16. Causes Of Constipation  Disease process  Immobility  Anorexia  Insufficient fluid and dietary intake  Hospital environment  Drug therapy in particular pain killers

17. 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

18. Drug Treatment of Constipation  Lactulose  Senna  Movicol  Suppositories/Enemas