People suffering from cancer and other terminal conditions reach a stage where they are dying. This process can take several weeks and may involve much pain and discomfort. Palliative care is aimed at keeping them as comfortable as possible while attending to emotional and spiritual needs at the same time. Many last-stage patients move to a hospice where they receive expert palliative care.
Palliative Care for Gastrointestinal Problems
People in the last stages of life, commonly experience the following problems:
- nausea and vomiting
- constipation
- diarrhea
- incontinence
Most of these can be eased or controlled with medication, but attention should be given to diet and practical care. Work out which foods or liquids are best tolerated and ask medical staff to explain the different types of drugs and their effects. Practical supplies include bowls for vomiting, adult diapers, protective sheets on beds and wet wipes.
Oral problems are related to gastrointestinal difficulties and can also be troublesome in the last weeks of life. Brushing teeth may become difficult and thrush often flares as a side effect of medications. Mouth washes can help remove buildup on tongues and oral gels can control thrush. Salivary stimulants such as lime juice can relieve a dry mouth.
Palliative Care and Delirium
Confusion and disorientation are common in dying people. The condition is usually irreversible and the best thing to do is try and keep the patient comfortable. Delirium manifests in the following ways:
- short term memory loss
- hyper- or hypoactive behavior
- hallucinations
- incoherent speech
- paranoia
- disorientation
If a physical cause is apparent for the delirium, this can be treated with medication. Palliative care includes keeping the patient in a safe environment with adequate staff to care for him or her. Keep sensory overload to a minimum and place familiar possessions in the room. Restraints may be required in some cases or even tranquilization.
Palliative Care for Breathing Problems
A large percentage of dying people experience problems with breathlessness. Causes are myriad and medication, physiotherapy and oxygen can bring relief. Personal support is helpful as it helps the patient to relax. Understanding what is causing the breathing problems and training to breathe in different patterns can be effective. This often includes relaxation techniques and adjusting body position.
Palliative Care for Skin Conditions
Skin problems are common in terminal conditions and manifest in the following ways:
- itching
- sweating
- bed sores
- swelling
The condition should be treated medically for maximum relief and backed up by palliative care. Effective treatments include the following:
- Keep the patient’s nails short or cover the hands with soft cotton gloves.
- Keep the room at a comfortable temperature.
- Apply cooling creams and avoid soap.
- Change soiled or damp bedding.
- Turn the patient frequently.
- Use protective zinc and castor oil cream on incontinent patients.
- Gentle massage can shift fluid.
- Support hosiery or compression bandages can offer some relief.
The process of dying involves the body shutting down system by system and inevitably causes discomfort. Palliative care is designed to keep the patient comfortable rather than cure the problem. Hospices are designed to offer this type of care and are invaluable when family members are unable to cope with loved ones’ pain and discomfort.
Recommended reading: The Palliative Care Handbook by Dr Roderick D MacLeod, Jane Vella-Brincat and Dr A D Macleod, published by Hutcheson, Bowman & Stewart, 2002, ISBN 0-473-08172-5
Debbie Roome - Debbie Roome is an award-winning freelance writer, journalist and novelist with over 25 years experience.
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