Symptom Management

Managing symptoms is core business for palliative care. Nurses have a role to play in helping to achieve the best symptom control and optimum quality of life for people in their care. It is important to recognise that not all symptoms will be physical, but could be psychological, social, or spiritual, or have psychological, social, or spiritual components.

In many cases, you will support symptom management with a mix of pharmacological (with medicines) and non-pharmacological approaches. This includes supporting patients, families, and carers and providing feedback to other members of the care team including prescribers. For all symptoms the principles of management include consideration the cause, potential benefits and burdens of treatment, the patient’s place in the course of their illness, their overall goals of care and their wishes.

Highly distressing symptoms may be directly or indirectly related to disease and can have a significant impact on the quality of life of patients and their family and carers. Physical symptoms can affect a person’s ability to do day-to-day tasks and the things they enjoy. They can also have an impact on their physiological and psychological wellbeing and how the person is feeling mentally can affect the intensity of the symptom.

Dame Cicely Saunders coined the term “total pain” to acknowledge that the pain experienced by a palliative care patient has physical, psychological, social, and spiritual dimensions. Total pain incorporates the meaning of pain within the person’s context, and provides a rationale for the pharmacological, non-pharmacological, and behavioral management strategies that address the person’s suffering (psychological, social, existential, and physical).

It can be helpful to apply a “total” approach not just to pain but to all symptoms commonly experienced by people with a life-limiting illness.

In this section, we describe the assessment and management of ten common symptoms experienced by people with a life-limiting illness.

Symptoms:

• Appetite and weight Loss
• Bowel problems
• Delirium
• Dyspnoea
• Fatigue
• Malignant wounds
• Nausea and vomiting
• Pain
• Skin failure and pressure injuries
• Sleep disturbance.