Caring for a terminally ill person
Caring for a terminally ill person is predominantly relieving distress and discomfort during their final stages of life.
For all people with a terminal illness, there comes a time when treatment for the disease itself no longer has a realistic chance of producing a cure and may cause harmful or unpleasant side effects. From this point, active treatment may be gradually withdrawn, and care is focused on achieving a dignified death for the person, avoiding distressing symptoms, and providing a reassuring and comfortable environment in which to spend the last days or weeks of life. Such measures are known as palliative care.
Once it is established that an illness is in its final stages, issues such as where death will take place, how pain will be controlled, and fear of death itself will undoubtedly cause anxiety for both the affected person and his or her family. To address these issues, health care professionals trained to relieve the distress caused by terminal illness usually work in partnership with the family.
Caring for a child with a terminal illness
Caring for a dying child is an intensely emotional and harrowing experience for everyone involved. Many children are looked after at home during the final stages of an illness because parents wish to carry out the care themselves. Effective communication is vital, and it is particularly important that parents are able to discuss the illness openly and honestly with the child.
There is a network of children's hospices and specialist nurses trained to help parents come to terms with the experience of caring for a dying child. These specialists are also able to address particular problems, such as difficulty in assessing pain and distress in children who are too young or too ill to communicate effectively. Parents can be taught to recognize nonverbal cues, such as facial expressions and body language, that may indicate that a child is in pain.
The parents of a dying child may find it helpful to contact specialist support groups and to meet other parens who are in a similar situation.
One of the most difficult aspects of terminal illness for both the dying person and his or her family and friends is the acceptance of imminent death. When a terminal illness is first diagnosed, many affected people express disbelief and anger. Normally, these feelings of denial are gradually replaced by acceptance.
For the terminally ill person, fear of being in pain and overwhelming anxiety about the moment of death may contribute to depression (see Mental problems due to physical illness). Anxiety and depression can often be relieved by open and honest discussion, but in some cases, the doctor may prescribe antianxiety drugs or antidepressant drugs. Family members and friends may also benefit from emotional support.
Many people who have a terminal illness experience some degree of pain. Depending on the nature of the illness, a dying person may also have other symptoms, such as shortness of breath and nausea. In most people, distressing symptoms can be relieved using drug therapy or, in some cases, simple practical measures (see Relieving symptoms in a terminally ill person).
Most pain can be relieved with painkillers. Treatment is aimed at achieving maximum pain control with minimum side effects (see Pain). In some cases, even if pain is well controlled, there can still be sudden episodes of severe “break-through” pain that may often be related to movement. However, with careful planning, this occasional pain can often be anticipated and avoided.
Relieving shortness of breath
A terminally ill person may experience difficulty breathing. This problem may be due to a lung disorder, such as pneumonia or pulmonary embolism, or to a build-up of fluid in or around the lungs. Shortness of breath may also result from anaemia, in which the oxygen-carrying pigment of the blood is reduced. If there is an underlying infection, antibiotics may help to relieve the symptoms. In many cases, shortness of breath can be alleviated by small doses of an opiate painkiller, such as morphine. Opiate drugs may also help to relieve anxiety, which often aggravates shortness of breath. The possibility of addiction to prescribed opiate drugs is not a cause for concern in the treatment of a person with a terminal illness.
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