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Symptom Management

This section describes the most common symptoms faced by patients with palliative care needs and how to manage these symptoms at an elementary level.

Pain

  • Introduction

    Why is pain assessment important?

    • To define the cause of pain so that appropriate treatment can be given
    • To monitor response to treatment

    How to assess pain?

Diarrhoea

  • Introduction

    Diarrhoea is defined as the passage of more than 3 episodes of unformed stools in a day.

    Problems that can result from diarrhoea

Delirium

  • Introduction

    What is delirium?

    • Acute deterioration in cognitive function accompanied by fluctuations in conscious level leading to disorientation and confusion
    • 3 clinical subtypes:
      • Hypoactive
      • Hyperactive
      • Mixed

    How can delirium be diagnosed?

Dyspnoea

  • Introduction

    Dyspnoea is “a subjective experience of breathing discomfort consisting of qualitatively distinct sensations that vary in intensity”, as defined by American Thoracic Society.

    How to assess dyspnoea?

Hiccups

  • Introduction

    Hiccups are forceful contractions of the inspiratory muscles produced by recurring, unpredictable contractions of the diaphragm. They can be persistent and distressing to patients. Hiccups are considered persistent if it last more than 48 hours.

Nausea and Vomiting

  • Introduction

    Nausea, the unpleasant sensation of being about to vomit, can occur alone or can accompany vomiting. Vomiting is the expulsion of gastric contents through the mouth.

Pruritus

  • Introduction

    Pruritus (itch) is an unpleasant sensation of the skin or mucous membranes that provokes the desire to scratch or rub. It can be distressing if persistent or widespread.
    Pruritus can be categorised as:

Nutrition and Hydration

  • Introduction

    Artificial nutrition and hydration is defined as the nutritional and hydration support of an invasive nature requiring the placement of a tube into the alimentary tract or parenterally via intravenous or subcutaneous means.
    Decisions on artificial nutrition and hydration must be made on an individual basis. Communications with patient and family is an important component of this decision.

Terminal Secretions

  • Introduction

    Respiratory secretions (rattling) are often observed in an imminently dying person. The cause is suspected to be due to salivary secretions or bronchial secretions accumulating in the pharynx and upper airways as patient becomes increasingly unconscious.

    It often indicates a short prognosis. In general it is within hours to short days after secretions are first diagnosed.

  • Management

    Non pharmacological Approach

Contact: lcpc@duke-nus.edu.sg

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