The Palliative Response by F. Amos Bailey

By F. Amos Bailey

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5. Hypodermoclysis offers a simple technique of administration of subcutaneous fluids, but policies and staff training in most clinical settings do not support its use. Burdens include possibility of dislodging needle, necessity of restraints, pain and swelling at site, risk of fluid overload, and cost of treatment. 6. Parenteral intravenous administration of fluids can be difficult and painful. Its use risks infections, restraints and fluid overload and creates a barrier to home care. 7. Key considerations in palliative hydration include evaluating burdens and benefits in the context of Goals of Care, seeking reversible cause, trying oral route, and observing for safety if an invasive route is indicated as a bridge to oral hydration.

Palliative Medicine 14 (2000): 121–127. 3 Co n st i p at i o n K e y P o i n ts 1. Assess all patients at Life’s End for constipation. Evaluate for obstipation after 48 hours without a bowel movement. Over half of patients at Life’s End suffer from constipation. Inquire about bowel habits (frequency, consistency, and previous habits), other symptoms (nausea/vomiting, abdominal pain, distention, anorexia, and diet), and attempted interventions. Obstipation is such severe constipation and impaction that there is a functional bowel obstruction.

Dyspnea is the subjective sense of breathlessness or smothering. Patients can self-report the severity of their dyspnea using a scale similar to the pain scale. Hypoxia and dyspnea are not always concordant; patients with hypoxia may or may not have dyspnea. Dyspnea is reported by over half of patients at Life’s End. 2. Dyspnea may have multiple causes. Palliative care does not exclude the search for and treatment of the underlying causes of dyspnea. Palliative care recognizes that the causes of the dyspnea may not be responsive to treatment or that the burden of treatment may outweigh the benefit.

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