Cancer Diagnosis - Physical Needs of the Person With Terminal Cancer
Meeting the physical needs of the dying is aimed at providing as much comfort as possible. The change from curing to caring means providing comfort with the least invasive procedures, while maintaining his/her privacy and dignity. A terminally ill person has many of the same needs as any seriously ill person, including the following:
- A routine for sleep and rest
Lack of sleep may be caused by the number of visitors, discomfort, fear of not waking up, restlessness, or day/night confusion. Keep a night light on and/or a bell or intercom available so the patient will know where he/she is if awakened and confused. A clock is also helpful.
- Nutritional considerations
Nutritional considerations may be difficult to address. Nausea, vomiting, diarrhea, constipation, and reduced eating are often associated with the effects of treatment and the progression of the disease. High-protein shakes may be an option if the patient is only able to eat or drink small amounts. A nasogastric or gastric tube is another option for supplemental nutrition. A gastric tube is placed through the skin into the stomach. A nasogastric tube is a tube placed in through the nose that extends to the stomach for delivery of medications and/or nutrition for digestion. Total parenteral nutrition (the delivery of nutrients, calories, protein, fat, and/or all caloric needs through a vein) is given into the bloodstream and may be necessary if significant nausea, vomiting, and/or diarrhea are present. An evaluation of the options available to provide nutrition will be discussed.
- Changes in elimination
Changes in elimination may also occur with a seriously ill or dying person. Diarrhea, constipation, and incontinence are all possible. Care should be given to provide the individual with a clean environment. It is also important not to embarrass or humiliate a person that has recently become incontinent (unable to control the bowel or bladder).
- Skin care
Skin care may also be a concern. Nutritional status, elimination problems, and immobility can all cause skin breakdown and/or pain. Infection may likely occur in this situation. The decision to use antibiotics can be discussed with the physician.
- Respiratory changes
Respiratory changes may occur from pneumonia, the effects of narcotics, or the progression of the disease. Often, patients will feel they are unable to "catch their breath." Air hunger, as this is often called, can be frightening. Decreased oxygen in the bloodstream may also cause a seizure. Oxygen supplied through the nose or by a mask may be needed simply for comfort. Sometimes medications can also lower the person's anxiety related to breathing difficulties.
- Nasal symptoms
Secretions from the nose, mouth, and throat may be difficult to manage with a terminally ill person. Suction devices are available, or simply repositioning the patient may help drain the excess secretions. There are also medicines that help lessen the amount of secretions.
- Pain management
With someone who is dying, one of the greatest fears is pain. Every measure should be taken to eliminate pain from the dying process. Pain control options and management plans should be discussed before the person experiences significant pain. Fear of addiction to narcotics is common among families. It is important to understand, however, that the ultimate goal is comfort, which means taking appropriate measures to assure that the patient is free from pain. Addiction is rare when pain medication is used appropriately to treat pain.
Pain is a sensation of discomfort, distress, or agony. Because pain is unique to each individual, a person's pain cannot truly be judged by anyone else.
Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and the pain generally disappears when the injury heals. Chronic pain may range from mild to severe, and is present to some degree for long periods of time. Medicating pain before it becomes too severe is advised. If pain medication is not given for a long period of time, it may not be as helpful. With chronic pain, long-acting pain medication may be given on a regular schedule over a 24-hour period.
Many people believe that if a person has been diagnosed with a terminal illness they must be in pain. This is not necessarily the case and, when pain is present, it can be reduced or even prevented. Pain management is an important topic to discuss with your physician.
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