Physical Care of the Patient
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.
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.
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.
