The main symptoms that we will focus on are nausea, vomiting, constipation, and skin breakdown. The hospice philosophy seeks to enable the caregiver to provide proper care of their loved one and that includes symptom control. The hospice team will help prepare individuals and family members to take care of their loved one, provide the fullest most possible comfort and dignity while they are in their homes surrounded by the warmth and familiar environment of family and friends. This program of symptom control will guide you toward proper steps on how to take care of your loved one.

Skin Care. It is very important to try to keep the skin in good condition, unfortunately, this may be a difficult problem at times if your loved one is bed bound. Pressure ulcers, also called bedsores, often occur on patients who are confined to bed for long periods of time. Often when patients’ positions are not changed, bedsores can also occur. These bedsores occur usually over bony parts of the body, such as the tailbone, the back of the head and ears, hips, spine, elbows, ankles, heel and shoulder blades.

Prevention of Pressure Ulcers. First explain to your loved one the importance of turning frequently even though they may not want to. Perhaps you may give them their pain medication 15-30 minutes before you turn them. Use pillows to support the patient while they are lying on their side. Keep the skin clean and dry. Apply lotion around the area of the pressure once or twice each day and gently massage the area. If you see redness around these bony areas, please tell your hospice nurse immediately or the home health aid and ask her to contact the hospice nurse. Your hospice nurse may suggest an air alternating pad to go under your loved one on the bed or an egg crate mattress (used more to provide comfort than to prevent pressure ulcers). There are also heel and elbow protectors that can be used to reduce the friction when the patient moves on the bed linens. If there is a skin breakdown, your nurse will contact the physician as soon as it is discovered and methods of treatment will be suggested to promote healing. Please note: donut rings under the patient in the bed is not recommended. They prevent the blood from getting to the bony area and therefore can create more problems. Please make sure the skin is regularly cleaned with soap and water and lotion is applied. Ask your hospice nurse for additional suggestions and once again, be sure to tell them of any redness, sores or bruises that you may discover.

Nausea and Vomiting. Nausea and vomiting may be due to the disease process and other times may be related to the medications you are taking. Before nausea becomes a daily problem, please make sure you tell your hospice nurse that this is occurring. Your hospice nurse will advise you on different methods of preventing nausea. Also the physician may need to be notified in order that an anti-nausea medication can be prescribed. Some suggestions to relieve nausea and vomiting: 1) take the anti-nausea medication as per the nurses’ instructions. Ask questions of the nurse as far as how long it lasts, how soon will it take effect and possible side effects. 2) Avoid excessive movement. 3) Avoid liquids at mealtime. Drink them an hour after the meal. 4) Eat small frequent meals. We suggest six small meals during the day rather than three regular large meals. 5) Pay close attention to mouth care. If vomiting persists or occurs, make sure you wash the mouth out well, possibly with a mild salt solution in order to keep the mouth clean. 6) Clear liquids, dry toast and soda crackers may help diminish nausea. Forcing food and fluids usually increase discomfort. 7) Remove offensive odors, sights and sounds. A quiet, calm environment is very relaxing. 8) Provide good ventilation. 9) When food is desired, begin with a clear liquid. Avoid greasy, fried and fatty foods. Small portions should be eaten very slowly. Try to avoid favorite foods when nauseated because the association between the nausea feeling and not being able to tolerate the favorite food will be involved. Call the hospice nurse if nausea and vomiting lasts more than 24 hours and is associated with any new medication that you have begun; is accompanied by abdominal pain or constipation, or if there is any blood found in the vomitus.

Constipation. Constipation is a common problem in people who are taking certain medications. Your hospice nurse will advise you on steps to prevent constipation from occurring. Your bowels should move at least every three days. Drink as much fluid as you can – try to eat bran cereals at least once a day. Vegetables and dried fruits such as prunes, raisins and apricots are very good for you. Nuts, grains, and oatmeal (even oatmeal cookies) have the bulk you need. Ask your nurse to suggest a stool softener or laxative when needed and the nurse will consult the physician for medication for you. At times when bowel movements have not occurred in three or more days, a mild enema may be needed to relieve the problem. Consult with your hospice nurse and she will assist in relieving this problem. Remember, do not wait until constipation is a problem. Establish a regular program for taking laxatives or a stool softener.

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