Patient Care and Monitoring

Other symptoms that are commonly observed in palliative care that the practitioner should monitor:

• Depression: Patients may need to experience quicker symptom relief than typical antidepressants may provide. In some cases, methylphenidate may be an appropriate, short-term option for treatment.

• Insomnia: Many times, patients experience insomnia due to a lack of appropriate symptom management. Treatment should begin with uncontrolled symptoms. Sleep disruption should be minimized and good patient assessment is necessary to effectively manage insomnia.

• Constipation: Most patients experience constipation as a result of opioid use, which requires management with a stimulant laxative; other drugs, poor hydration, dietary supplements, and immobility may contribute to constipation as well. Careful assessment of etiology is important before implementing treatment.

• Diarrhea: Patients experiencing fluid loss through excessive diarrhea need to be monitored for dehydration and electrolyte imbalance. Fluid replacement is typically the first line of therapy in addition to drug therapy to minimize the symptom. Over flow diarrhea from constipation or a bowel obstruction is often misdiagnosed and treated inappropriately, worsening the problem.

• Dysphagia: Difficulty swallowing is common in end-of-life patients and may necessitate that medications be given through alternative routes of administration. Knowledge of drug absorption and disposition when administered rectally, sublingually, and topically is key in good clinical decision making.

Abbreviations Introduced in This Chapter

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