Palliative Care Australia

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Symptom Management in Palliative Care

Possible Symptoms Treatments
Secretions
  • Educate family, often more distressed than patient
  • Positioning. Avoid suctioning as stimulates cough & distress
  • Glycopyrrolate 0.2-0.4mg s/c 15min prn, max 6 doses 24 hours
  • Buscopan 20mg SC PRN/4hourly
  • If patient distressed by it, may need some sedation
Dry Mouth
  • Artificial Saliva
  • Suck on ice / frequent mouthwash with water
  • Sugar free pineapple pieces
  • Frozen lemon slices
  • Frozen tonic water
  • Chewing gum
Dyspnoea
  • Educate family/carers
  • Fluid restriction for fluid overload
  • Fan to provide air movement
  • Morphine 1 – 2.5 mg SC or orally if opioid naïve
  • Slow release opioids with specialist advice
  • O2 subject to assessment
Twitching
  • Education, warn that effective management involves sedation
  • Clonazepam  0.25-0.5 mg nocte orally
  • Midazolam 2.5mg SC 1/24/prn
Nausea / Vomiting
  • Metoclopramide 10 mg PO TDS

·       Haloperidol  0.5 – 1.0 mg  SC 1/24 prn

Low appetite
  • Education of family
  • Sometimes a trial of steroids
Low energy
  • Education of family
  • Graded activities – energy conservation/utilisation
  • Sometimes a trial of steroids
Sleep Disturbance
  • Education, sleep hygiene, individual needs
  • Trial Temazepam 10-20mg nocte
Delirium
  • Education, identify treatable causes i.e. pain, constipation
  • Haloperidol 0.5 – 1.0 mg 1/24 prn
  • Clonazepam 0.25 – 1 mg nocte
  • Midazolam 2.5 – 5 mg SC hrly/prn
Client Home visits
  • Recommend daily visit by Health Clinic at end stage
Equipment

Organise equipment through Disability or Territory Palliative Care

Syringe Driver available if needed via TPC

Allow time for transport of equipment and medication to community

  • TPC Afterhours emergency advice/support  1800 642 713
 

 

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