Common Symptoms and Comfort Measures

The patient should feel that he/she is at all times receiving competent, loving care by all concerned. There are certain signs and events which are likely to occur and which if anticipated and understood, can be satisfactorily attended to. We sincerely hope that the following information and suggestions will make it easier for you to care for your loved one.

The control of pain is the most important function in the care of the patient. Pain is subjective and is very real to the patient. It is better to give pain medication in anticipation of the pain rather than waiting for pain to occur. Hospice typically uses a phased approach to pain control staring with mild analgesics and progressing to narcotic pain medication. The goal is to control the pain with the mildest medication that is effective.

You can help your nurse and physician determine the most effective pain control regime by keeping careful records of the pain the patient is experiencing. Record the date, time and circumstances causing the pain. Record the location of the pain and the relief given by medications. It is important to be honest about how bad and how frequently you experience pain. No one should have to suffer pain needlessly.

Hypothermia is a decrease in body temperature. The extremities and body tend to cool and the patient complains of being cold or chilled. Warm blankets should be used as indicated.

An elevated temperature with increased perspiration sometimes occurs. The patient may be sponged or bathed with tepid water for cooling. Frequent changes of bed clothes and linens are often required if this occurs.

Increased sleeping is normal at this time. This may be due to the pain medication or to the disease or both. If the patient can be easily aroused, there is no concern. If not, the medication may need to be reduced.

Shortness of breath or breathing difficulties is common for a patient who is very ill. Breathing difficulties can create a decreased oxygen level in the body. Signs of low oxygen may include a restless or anxious feeling and a rapid breathing rate. Be calm and reassuring, raise the head of the bed or place pillows behind the back and head to make breathing easier. The nurse will check breathing on each visit. If breathing problems exist, the nurse will discuss the possible need for oxygen therapy.

Confusion and disorientation to time, place and person may occur for the above same reasons. This is usually temporary but may recur. Reassure the patient frequently as to time, date, place and person present. It is recommended that the patient not be left alone for long periods of time during a state of increased confusion

and disorientation. Precautions should be taken for the patient’s safety.

Loss of control of either bowel or bladder may occur. The staff nurse or the home health aide will give instructions in proper management of this problem. It is of utmost importance that the buttocks and genital area be kept as clean and dry as possible to prevent skin irritation and possible breakdown.

Oral secretions may be profuse and thick. The patient, because of weakness, may be unable to cough and expel sputum. Increased fluid intake may be helpful. Lying the patient on his/her side will permit the secretions to flow out of the mouth so that they can be removed by swabs or a wash cloth.

Diminished need for food is normal. Encourage small, frequent feedings of whatever the patient desires and at times when he/she is more alert. Do not attempt to force any food or drink. Nutritional supplement may be needed and will be discussed by the staff nurse as necessary.

Diminished hearing and vision do occur. Try to avoid shouting at the patient. Speak clearly and slowly. Some patients may prefer a light on so they can see and know their familiar surroundings.

Irregular breathing during sleep is common. Short periods of no breathing, actually holding the breath, will occur.

Diminished urinary output is normal as liquid intake decreases. However, if a catheter has been inserted, be sure that it is open and draining by checking to make sure the catheter is straight and there is no pressure on the tubing.