Pain may become a permanent part of the patient's life. The physician prescribes painkilling drugs in adequate amounts and explains how to use them. Do not wait until the patient complains of pain before giving the drugs. It is easier and more effective to administer them at regular intervals.
The bedridden patient accentuates the practical problems of dealing with a terminally ill patient. The routine of caring for a chronically sick person is by now well established. The family must realize that deterioration is going to continue. Although the patient's loss of weight makes some aspects of nursing easier, the skin is more likely to be damaged without the protection of fat and muscle. It may take two adults to move the patient on and off the bedpan. A visiting nurse can help with bed-bathing and can show the family how to carry out the more complicated procedures. The physician may advise the family on the use of drugs and how to insert suppositories to treat constipation or other symptoms.
Nausea and vomiting are often more distressing symptoms for the family and patient to deal with than pain. The symptoms may be combined with hiccupping, which exhausts the patient. The physician can prescribe drugs to control this. These drugs can also have a sedative effect if taken with painkillers. Although they can produce confusion and drowsiness, the drowsiness often benefits the patient. The drugs may prevent the patient from feeling thirsty, so it is important to encourage him or her to drink. Assist the patient by offering frequent drinks of cool, sweetened fluid, such as fruit juice, iced water, or herbal teas that freshen the mouth but do not have strong flavors.
If the patient is suffering from a heart or lung disease, coughing may be one of the symptoms. This distresses and exhausts the patient. The family also finds it disturbing. It is most important to control the coughing at night and so allow the patient and family a peaceful sleep. Try changing the patient's position in bed. A steam inhalation at bedtime reduces irritation and helps to prevent sleep-disturbing cough. Broken sleep is exhausting for the family and the patient. If sleeplessness continues, it is sensible to arrange alternative care every other night if possible.
Another symptom of heart or lung disease is shortness of breath. Coughing, or the smallest physical activity, can make the patient gasp for breath. This causes great distress. The physician may prescribe oxygen that can be used effectively after a bad bout of coughing or rapid physical movement.
The patient's strength and personality may cope with pain in a surprising manner. However, incontinence of urine and feces is a humiliation few can tolerate. The situation requires immense care and tact, as well as tolerance, from those nursing the patient because they must cope with the physical and psychological misery that incontinence produces. It is important that, despite the unpleasantness, the family should not let the patient feel that he or she is an intolerable burden. Incontinence must be accepted with sympathy and understanding.
As the patient becomes physically weaker, the physician administers more drugs. The mental state of the patient changes for an alert, realistic individual, to one who is often confused about time and place. This confusion varies, and periods of normal discussion fluctuate with moments of drowsiness and loss of reality. Often the patient is aware that he or she has been confused and is apologetic for the trouble caused.
Visitors should come for only a short time. It is best if they know the patient well and can remain peaceful and silent. If necessary, they can just hold the patient's hand. This physical contact is a form of communication that can produce peace and contentment.
During the patient's deterioration, the appetite is usually lost. Offer the patient small amounts of his or her favorite foods, jellies, or soups. Serve small portions of food frequently.
If at any time the family feels that they cannot cope with the situation any longer, discuss the problem with the physician. It may be that the time has come for the patient to be hospitalized and it is wise to accept the physician's advice on this.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Death of a Baby
The intrauterine death of an embryo ends in a miscarriage (spontaneous abortion). Ten percent of pregnancies end in this way, commonly between the sixth and tenth weeks, and usually because of an abnormality in the embryo. With care, subsequent pregnancies are usually successful.
Care of the Dying - Reaction of Children
A child's reaction to death depends on many factors. A child's first experience with death is often the death of a pet. A child under the age of eight cannot understand that death is irreversible and may expect the mother or father to bring the pet back to life. After the age of eight or nine, the child's understanding is usually as rational as an adult's understanding.
