title: Care of Patients at the End of Life: Management of Nonpain Symptoms.
abstract: Management of nonpain symptoms can improve quality of life for patients at the end of life and their family members. Constipation is the most common nonpain symptom. It can be related to opioid therapy and/or medical conditions. After abdominal examination to detect masses or evidence of bowel obstruction and rectal examination to exclude fecal impaction, constipation should be managed with a stimulant laxative (eg, senna) or an osmotic laxative (eg, sorbitol). Dyspnea also is common, and often improves with use of a fan to blow air into the face, as well with breathing and relaxation exercises. However, many patients require titrated doses of opioids to address respiratory depression, and anxiolytics such as haloperidol may be needed to manage dyspnea-related anxiety. Oxygen typically is not effective in dyspnea management in nonhypoxemic patients at the end of life. Cough is managed with antitussives. Nausea and vomiting occur in 70% of patients in palliative care units. If no reversible etiology can be identified, dopamine antagonists and motility-enhancing drugs can be used. There are no clearly effective treatments to manage noisy respiratory secretions, but position change, decrease in fluid intake, and drugs such as scopolamine or glycopyrrolate may be effective.
authors.affiliation: Mercer University School of Medicine Department of Family Medicine, 1550 College Street, Macon, GA 31207-0001.
authors.forename: Florence T
authors.initials: FT
authors.lastname: Baralatei
authors.affiliation: Mercer University School of Medicine Department of Family Medicine, 1550 College Street, Macon, GA 31207-0001.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ackermann
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000996:Antitussive Agents / Q000627:therapeutic use; D001945:Breathing Exercises; D003248:Constipation / Q000188:drug therapy*; D003371:Cough / Q000188:drug therapy*; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D004417:Dyspnea / Q000628:therapy*; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D009325:Nausea / Q000188:drug therapy*; D011788:Quality of Life; D012064:Relaxation Therapy; D013727:Terminal Care; D014839:Vomiting / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D000996:Antitussive Agents; D018492:Dopamine Antagonists; D054368:Laxatives