Module 3 Symptom Management Core Curriculum Module 3 Symptom Management

Section I: Introduction Essential Elements of Symptom Management Assess, plan, intervene, evaluate Ongoing assessment and evaluation Requires interdisciplinary teamwork Reimbursement concerns (affordable options) Research is needed Coyne et al., 2015

Symptoms and Suffering Symptoms create suffering and distress Psychosocial intervention is key to complement pharmacologic strategies Need for interdisciplinary care

Symptom Management in the Older Adult May have several symptoms with multiple co-morbitities Majority of hospice diagnoses are non-cancer related, associated with heavy symptom burden Congestive heart failure (CHF) Chronic obstructive pulmonary disease (COPD) Dementia Other Social isolation

Common End-of-Life Symptoms Respiratory Dyspnea, cough GI Anorexia/cachexia, constipation, diarrhea, nausea/vomiting, xerostomia Psychological Depression, anxiety, post-traumatic stress disorder, delirium/agitation/confusion General/Systemic Fatigue/weakness, wounds, seizures, sleep disturbances, lymphedema, and urgent syndromes

Case Study on Assessment and Management of Symptoms: MARGARET—Part I 42-year-old single, unemployed female Lives alone in a rural community and has no living family members Diagnosed with CHF, hypertension, & diabetes six years ago. Weight = 245 lbs A 2 ppd tobacco smoker since she was 16 years old Diagnosed with emphysema last year Today, she weighs 360 lbs On Medicaid Margaret is a 42 year-old single, unemployed female who lives alone in a rural community. Six years ago she was diagnosed with congestive heart failure (CHF), hypertension, and type 1 diabetes. At the time of diagnoses, she weighed 245 pounds. Six years later, she weighs 360 pounds. She has been a 2 ppd tobacco smoker since she was 16 years of age. She was diagnosed with emphysema last year. She has been on Medicaid since diagnosed with CHF and diabetes. Social services brings her food 3x/week and she receives meals on wheels daily. She primarily lives in the family room, where she stays in a recliner day and night. She has no living family members and has very few acquaintances, as she isolates herself in her home. She has frequent episodes of anxiety, which exacerbates her dyspnea and hypertension. When this occurs, she dials 911 and is taken to the nearest hospital, which is 50 miles from her home. In the past six months, she has been admitted to the hospital 3 times. Stop and Consider: Is Margaret a candidate for palliative care? If so, what symptoms could the palliative care team assess and manage? The nurse would certainly play a critical role in the team. What other disciplines should be included? Margaret’s case will continue throughout this module.