Symptom Management Flashcards
Range for the percentage of Pts with advanced disease admitted to hospital who experience insufficiently managed pain
40-50%
Why SW should be aware of physical symptoms?
Core of PC philosophy: Consider total pain
Ethical obligation: Dignity NASW Standards
Best advocates considering cultural/spiritual environment
What is meant by “total pain/total suffering as core principle of PC?
Physical symptoms are only part of a Pt’s experience
emotional/social/spiritual context contributes to ability/inability to experience a good quality of life, free of distress, to heal
Physical symptoms and psychosocial/spiritual stressors interact with each other to increase stress
Why are SW responsible for ID Pt’s physical symptoms and challenges?
Primary barrier to effective symptom management are psychosocial
SW may be 1st on the team to notice a change in Pt or their behavioral pattern
Pt may reveal their concerns or symptoms more freely to SW
Report any concerns/observations to the health care team
Promote problem solving with advocacy, emotional support, coping skills
explain “Advocacy” in relation to SW responsibility to symptom management
Encourage Pt and family/caregivers to openly and accurately share information; and advocate for health care team when Pt/Family are unrealistic in demands or expectations. Pt’s may be undertreated for their pain as a result.
Explain “Emotional Support’ in context of SW role on health care team
Help Pt and family feel heard and understood and experience a connection to the health care team
What concerns should prompt a SW to discuss symptoms with health care team?
Pt is admitted frequently for symptom control
Symptoms not responding to tx (intractable)
Pt has communication challenges–uncomfortable divulging, or does not understand medical language
Pt or family feeling overwhelmed by choices
Pt dying
What are the psychological bases of physical symptoms?
Mind body connection
Trauma history
common symptoms seen in Pt with advance diseases?
pain loss of appetite nausea/vomitting sleeplessness dyspnea constipation depression loss of bladder control
Variables influencing physical symptoms
Disease progression medication/treatment diagnosis Pt's emotional state Proximity to death Availability of appropriate PC/Hospice management
Advantages of early integration of PC
preempt major symptomatic issues or side effects of medicatoin/tx
Intro at time of dx of life altering dx ideal–often not accomplished
Guides Pt to ID symptoms/side effects, report these before they get out of control, learn coping/relaxation/breathing strategies before symptoms necessitate them
Decreased level of stress with ADirective and ongoing goals of care discussions
What is the benefit of using scale to measure pain?
Faciltate standard reporting over time
Example of 2 pain intensity scales
Numeric Pain Intensity Scale
Pain Faces Scale
Dyspnea:
Edmonton Subscale (adults) scale 0-10, capture 9 common symptoms
Dalhouise Dyspnea Sclae (children with cystic fibrosis or asthma)
How does SW understanding of dyspnea provide decision making support?
Fans can be helpful
02 common but: Nasal cannula is drying/irritating
mask causes feeling of isolation/interfers with drinking/eat/talking
Help family weigh pros/cons on case by case basis
help family express their concerns to MDs
