Managing Symptoms Managing Symptoms in Palliative Carein Palliative Care

AimsAims

To gain an awareness of the most common To gain an awareness of the most common symptoms in patients with life limiting symptoms in patients with life limiting diseases and why these occurdiseases and why these occur

To identify your role in supporting patients To identify your role in supporting patients and their families with these symptomsand their families with these symptoms

To understand how to promote patient To understand how to promote patient comfort and improve the quality of carecomfort and improve the quality of care

What are common symptoms?What are common symptoms?

BreathlessnessBreathlessness FatigueFatigue

BreathlessnessBreathlessness

What are the causes of What are the causes of breathlessnessbreathlessness

CausesCauses

Primary and secondary cancerPrimary and secondary cancer Heart failureHeart failure COPDCOPD Anxiety and fearAnxiety and fear Fluid overloadFluid overload Respiratory muscle weaknessRespiratory muscle weakness InfectionInfection AnaemiaAnaemia Others?Others?

How it feels…How it feels…

Difficult, laboured and uncomfortable Difficult, laboured and uncomfortable breathingbreathing

May experience significant panic associated May experience significant panic associated with breathlessnesswith breathlessness

Impacts on quality of lifeImpacts on quality of life

DyspnoeaDyspnoea

Causes anxiety in patients and carersCauses anxiety in patients and carers Patients describePatients describe -Unpleasant sensation of not being able to -Unpleasant sensation of not being able to

breathe easilybreathe easily -Feelings of exhaustion-Feelings of exhaustion -Tightness of chest-Tightness of chest -Extreme fear of suffocation or drowning-Extreme fear of suffocation or drowning Panic and anxiety – leads to an increase in rate of Panic and anxiety – leads to an increase in rate of

breathingbreathing

Impacts upon:Impacts upon:

Social – work, family role, house boundSocial – work, family role, house bound Spiritual – meaning in and of lifeSpiritual – meaning in and of life Psychological – fear, anxiety, depressionPsychological – fear, anxiety, depression Physical – oxygen dependency, loss of Physical – oxygen dependency, loss of

function and independencefunction and independence

Breathing RetrainingBreathing Retraining

Strategies already used by patientsStrategies already used by patients -slowing down-slowing down -avoiding triggers-avoiding triggers -pacing-pacing -deep breathing-deep breathing -relaxing-relaxing -use of fans -use of fans

Breathing RetrainingBreathing Retraining

Breathing ExercisesBreathing Exercises Sitting in a comfortable position gently Sitting in a comfortable position gently

squeeze your shoulders up to your ears, squeeze your shoulders up to your ears, then let go: repeat a couple of timesthen let go: repeat a couple of times

Start by relaxing your jaw and gently sigh Start by relaxing your jaw and gently sigh out through your mouth. In your own time out through your mouth. In your own time breathe in through your nose, if possible, breathe in through your nose, if possible, and then gently sigh out again.and then gently sigh out again.

Breathing RetrainingBreathing Retraining

Place your hands across your lower ribs, Place your hands across your lower ribs, just above your waist. Breathe out through just above your waist. Breathe out through your mouth, letting your ribs sink in as far as your mouth, letting your ribs sink in as far as possible. Then, breathing in through your possible. Then, breathing in through your nose or mouth, feel your ribs expand nose or mouth, feel your ribs expand outwards against your hands. Gently outwards against your hands. Gently breathe out to start again.breathe out to start again.

Repeat three or four timesRepeat three or four times

Square BreathingSquare Breathing

Focus on a rectangle, visualise the right hand Focus on a rectangle, visualise the right hand corner, then following the line down, sigh out until corner, then following the line down, sigh out until you get to the bottom right hand corner. Take a you get to the bottom right hand corner. Take a breath in, until you get to the bottom left hand breath in, until you get to the bottom left hand corner, then sigh out until you get to the top left corner, then sigh out until you get to the top left hand corner and breathe in until you reach the hand corner and breathe in until you reach the right hand corner.right hand corner.

   Repeat this two or three times.Repeat this two or three times.

What is your role?What is your role?

Communication – listeningCommunication – listening Recognition that breathlessness is frightening and Recognition that breathlessness is frightening and

uncomfortableuncomfortable Maintain dignity by providing help the patient Maintain dignity by providing help the patient

wants – promote independencewants – promote independence Help adjustment to limitationsHelp adjustment to limitations Promote calm environment Promote calm environment Cold air/Fans can be very effectiveCold air/Fans can be very effective Report symptoms and assess effect of interventionReport symptoms and assess effect of intervention

FATIGUEFATIGUE

Fatigue in Palliative CareFatigue in Palliative Care

Subjective, unpleasant symptom which Subjective, unpleasant symptom which ranges from tiredness to complete ranges from tiredness to complete exhaustionexhaustion

Interferes with individuals ability to function Interferes with individuals ability to function normallynormally

Common in cancer , chronic, life limiting Common in cancer , chronic, life limiting diseasesdiseases

FatigueFatigue

In healthy people fatigue is relieved by sleep In healthy people fatigue is relieved by sleep and restand rest

In cancer and chronic diseases patients In cancer and chronic diseases patients wake up feeling tired no matter how long wake up feeling tired no matter how long they have sleptthey have slept

Many causesMany causes Disease itself, treatment, psychological, Disease itself, treatment, psychological,

socialsocial

Why is Fatigue Difficult to ManageWhy is Fatigue Difficult to Manage

Often has more than one causeOften has more than one cause Patients find it difficult to explain/reportPatients find it difficult to explain/report Often lack of knowledge by health care Often lack of knowledge by health care

professionalsprofessionals Belief that nothing can be doneBelief that nothing can be done Failure to appreciate effect on the Failure to appreciate effect on the

patient/familypatient/family Knowing how to assess itKnowing how to assess it

What Can Be DoneWhat Can Be Done

Deal with the cause if possibleDeal with the cause if possible Pain management, infection, treat blood Pain management, infection, treat blood

abnormalitiesabnormalities Can anything be done?Can anything be done? Alter or change treatmentAlter or change treatment Reassure patient that if caused by cancer Reassure patient that if caused by cancer

treatment it can improve.treatment it can improve.

Your Role In FatigueYour Role In Fatigue

Crucial – Important to believe the patientCrucial – Important to believe the patient Often provide basic care and you can recognise Often provide basic care and you can recognise

changes or inability to self care/mobilisechanges or inability to self care/mobilise Identify signs that may be cause fatigue e.g. Identify signs that may be cause fatigue e.g.

breathlessness, panicky, not keen to do anything, breathlessness, panicky, not keen to do anything, withdrawnwithdrawn

Know the patients limitationsKnow the patients limitations Encourage and supportEncourage and support Encourage gentle exercise and mobilityEncourage gentle exercise and mobility Referrals to other HCP e.g. prior to discharge.Referrals to other HCP e.g. prior to discharge.