Palliative Care - Non-pain Symptom Management

Palliation in serious illness and end of life can be challenging and often is helped by a Palliative Care consultation. “Comort measures only” is NOT a one-size-fits-all set of orders (e.g., indwelling Foley may be more tolerable than frequent urinary incontinence, diuretics may still be indicated for relief of dyspnea or edema, etc.). For persistent/recurring sx meds should be made standing, with additional PRNs for breakthrough

 • Anxiety: often exacerbated by medications (steroids, appetite stimulants, etc.), undertreated pain, and dyspnea

 • Depressed mood: Can be difficult to distinguish between MDD, demoralization, and adjustment disorder. See Psychiatry section

 • Delirium: common and often multifactorial

 • Nausea/vomiting, Diarrhea, Constipation

 • Xerostomia: side effect of chemo/XRT, head/neck surgery, or medications

 • Fatigue: often related to disease progression, medications, other treatments, deconditioning, malnutrition, sleep disturbances, sx’s

 • Dyspnea: exacerbated by deconditioning, cachexia, worsens at EOL, exacerbates anxiety. Does not always correlate w/hypoxemia.

 • Secretions: pooled secretions  “death rattle”. Disturbing to observers, less bothersome to pt

 • Insomnia (inpatient management)

 • Catastrophic hemoptysis or hemorrhage: often preceded by “sentinel” small bleed. Be sure to prep pt/family for possibility.



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