Question

4)    You are posted in a palliative care unit and a patient named Brian is assigned to you. He has been diagnosed with terminal lung cancer. Brian is receiving chemotherapy and radiotherapy, Explain how do you take care of the client with regard to the following aspects? (30-40 words each)

Caring aspects

4.1)     Hydration

4.2)     Nutrition

4.3)     Respiratory difficulty

4.4)     Swallowing difficulty

4.5)     Nonpharmaceutical and complementary care for managing pain

4.6)     Social and emotional wellbeing

Answer 1

4.1, Vomiting and diarrhea caused by chemotherapy or radiotherapy are two of the most common risk factors for developing dehydration. Dehydration is often accompanied by dizziness, dry or sticky mouth and dry skin. Additionally, one of the most reliable indicators is dark, concentrated urine. Other symptoms of dehydration is decreased urine output, headache and thirst.

Hence effective hydration is essential for the patient who is getting chemotherapy and radiotherapy. Oral rehydration of ORS is an effective for onset of dehydration , Still if its not cured, start IV drip. Other symptoms can manage by symptomatic treatment like, for diarrhea, choose drinks that have sodium and potassium to help replace these lost minerals. If there is fatigue, keep ice and drinks within reach so patient do not have to get up more often than necessary. Provide antiemetic for vomiting.

4.2, Loss of appetite can be a result of disease and treatments of chemotherapy or radiotherapy, side effects of medications, unpleasant symptoms like constipation, nausea or pain or because of worry and stress. Eat small amounts often, try to eat light meals and snacks or have a nourishing drink every 2 hours. Avoid low fat or diet foods, choose full fat milk, thick and creamy yogurts and puddings. Eat food slowly in a relaxing environment and continue to relax after you have finished eating.

4.3

• Positioning - the most comfortable position is usually sitting upright with support.
• Keeping the room cool.
• Moving air from a fan (hand-held or stationary) or open window helps provide psychological relief.
• Teaching and use of breathing exercises and relaxation methods. Breathing retraining, taught by physiotherapists or clinical nurse specialists.
• Oral morphine is widely used to manage dyspnoea, although the mechanism of action is not fully understood. The anxiolytic and antitussive effects of diamorphine make it ideal for lung cancer.
• Diazepam, lorazepam and midazolam can be used, according to the severity of anxiety.
• Oxygen should be used only where the patient is shown to be hypoxic.
• Shift to a hospital environment, if its deteriorating.

4.4    Don’t wait for swallowing problems to start. Many patients benefit from starting swallowing therapy before cancer treatment, especially those with cancer in the throat. Therapy may include: use of feeding tube, medication and refer a speech therapist.

• Provide soft, smooth foods, such as yogurt or pudding.

• Mash or blend foods. Or moisten dry foods with broth, sauce, butter, or milk.

• Try thickening liquids. Add gelatin, tapioca, baby rice cereal, or commercial thickening products.

• Use a straw to drink liquids and soft foods.

• Provide cold or room-temperature foods to reduce pain.

• Take small bites, and chew slowly and thoroughly.

• Sit upright when eating or drinking.

• Provide small, frequent meals.

• Choose foods high in calories and protein if you are losing weight. Such foods include eggs, milkshakes, casseroles, and nutritional shakes.

• Avoid dry, coarse, or hard foods.