Assessment and treatment of physical symptoms

The 2018 National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines includes recommendations for palliative care assessment and planning.

Guideline 1.2: Comprehensive palliative care assessment. A comprehensive interdisciplinary evaluation of the patient and family forms the basis for the development of an individualized patient and family palliative care plan.

Guideline 1.3: Palliative care plan. In collaboration with the patient and family, the interdisciplinary team (IDT) develops, implements, and updates the care plan to anticipate, prevent, and treat physical, psychological, social, and spiritual needs (Ferrell et al., 2018).

With the growth of palliative care came an increased number of assessment tools available for nurses and the IDT team to determine the type and degree of severity of symptoms befalling patients. There are currently many professional articles and websites that address the care of the patient receiving palliative care. What is presented here is a general overview of care parameters. The reference list contains articles and websites for more detailed information.

Common serious illness in patients needing palliative care include the following:

• Cancer
  
• Heart Disease/CHF
  
• Respiratory Disease/COPD
  
• Renal Disease/Failure
  
• HIV/AIDS
  
• Chronic Liver Disease
  
• Multiple Sclerosis (M.S.)
  
• Alzheimer's Disease
  
• Stroke (CVA)
  
• Amyotrophic Lateral Sclerosis (ALS) 

Typical physical symptoms occurring to palliative care patients are as follows:

• Pain
  
• Constipation
  
• Nausea and vomiting,
  
• Anorexia
  
• Dyspnea
  
• Fatigue
  
• Fever
  
• Delirium (Albert, 2017; Dalal et al., 2006; Strasser, et al., 2004)

Pain, dyspnea, and fatigue have been the most common of all these symptoms reported by approximately 50% of patients (Solano et al. 2006). According to Albert (2017), here are some general principles for treating patients receiving palliative care and end-of-life care.

• Treat the primary cause of a symptom, i.e., if anxiety is caused by dyspnea, treat the dyspnea.
  
• Medications should generally start at lower dosages, titrating to the desired effect.
  
• Use proactive regimens to prevent symptoms.
  
• Medications must be provided in formulations that are safe and feasible for administration for individual patients.

Overall assessment approach

One of the essential roles for nurses and the IDT in palliative care is assessing the patient's symptoms and discomfort levels. Here is a general assessment approach, from minimum to severe, derived from the Edmonton Symptom Assessment Scale (ESAS) that includes the above common symptoms experienced by palliative care patients (Rauenzahn et al., 2017). https://www.albertahealthservices.ca/assets/info/peolc/if-peolc-ed-esasr-admin-manual.pdf

https://www.aafp.org/afpsort