1. Module 3 Symptom Management
Core Curriculum
Module 3 Symptom Management

2. 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

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

4. 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

5. 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

6. 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.