Teaching Sheets Three
Hiccups
Insomnia
Itching
Mouth Care
Pain Management
Pain – Pace Yourself
Pressure Sores

Definition: A hiccup is a spasm of the diaphragm (the muscle used in breathing found under the lungs).

Problems – Hiccups can cause:

• Interruption in sleep
• Vomiting, if occurs when eating
• Pain at times

• Excess of air in the stomach
• Irritation of the nerve that controls the diaphragm
• Tumors of the neck, lung, esophagus
• Metabolic disorders: uremia, sepsis, hypocalcemia

• Breath slowly and deeply into a paper bag ten times and repeat if needed
• Rapidly swallow two glasses of warm liquid
• Rapidly swallow two teaspoons of granulated sugar
• Drink peppermint water
• Medications prescribed by your physician

Insomnia

Problems – Insomnia can cause:

• Interrupted sleep patterns
• Fatigue due to lack of sleep
• Irritability
• Difficulty focusing
• Restlessness

• Worry and fears
• Pain
• Medications
• Difficulty breathing

• Deal with worries during the daytime
• Make sure your pain medication is adequate to last the night
• Exercise if possible
• Try taking less naps during the day
• Drink warm milk with honey at bedtime
• Take sleep medication as prescribed by your physician

Itching

Problems – Itching can cause:

• May cause redness, irritation to the skin
• Sleeplessness
• Agitation
• Infection

• Dry flaky skin
• Rash
• Change in detergents or diet
• Certain types of diseases or cancer
• Medication

• Apply lotions to bath water in place of soaps
• Apply cornstarch to skin folds by first applying to hands
• Keep room cool
• Wear loose clothes
• Take warm baths with Aveeno powder or a cup of baking soda
• Take medications as directed by your physician (if needed)

Mouth Care

Good mouth care is important all the time and becomes even more important when we are ill. Keeping a patient's mouth clean may help prevent aspiration pneumonia. Aspiration pneumonia is caused when a substance such as food, excessive saliva or any foreign substance is inhaled into the lungs. When patients are severely ill, they may not swallow as often and saliva accumulates in the mouth. When the patient inhales that saliva and bacteria from poor oral care it can add to the problem.

Also while doing mouth care, it allows the caregiver to inspect the mouth and tongue for signs of sores or reddened areas. These sores not only cause discomfort and pain but can cause difficulty eating or drinking.

Mouth are should be done at least 3 times a day after meals and when needed.

Supplies

• Toothbrush or toothette (a small sponge on a stick)
• Toothpaste
• A basin
• Face towel (to protect the patient's clothes)

• Help the patient sit in an upright position
• Place a towel around their neck
• Provide them with a toothbrush with toothpaste applied
• Allow them to hold the basin while rinsing their mouth out with water

• Wash your hands before starting mouth care
• Place the patient on his/her side if possible
• Place a towel under the patient's face
• Wet toothettes with cool water mouthwash (avoid alcohol-based mouthwash as they can cause dry mouth); liquid saliva (available in pharmacies) or papaya juice
• Gently open the patient's mouth and clean the teeth, gums, tongue and sides of the mouth. Make sure to observe for signs of discomfort.
• Look for reddened areas or sores at this time
• If the patient has dentures they should be removed and cleaned after each meal. Be aware that sometimes dentures can cause discomfort or a change in the facial structure and the dentures may not fit properly anymore. If this is the case, it may be necessary to keep the dentures out or have them adjusted by your dentist.

• Use ice chips or small amounts of water. Flavored ice chips can be used. Take any juice or Gatorade, place in an ice tray and freeze. These can then be crushed in a blender and given to the patient by spoon.
• You can also try giving the patient a clean wash cloth with water to suck on.
• Keep the patient's lips moist using lip balm.
• Use a humidifier.
• Increase fluids (if possible).

Pain

Problems – Pain can be physical, emotional, mental, spiritual, and financial and can cause:

• Depression/anxiety
• Change in a person's lifestyle
• Anger
• Social withdrawal
• Fear

• Trauma/injury
• Infection
• Tumors
• Cancer
• Emotional stress, spiritual stress and worries

• Medications as directed by your physician and the hospice interdisciplinary team
• Emotional and spiritual support
• Non-pharmaceutical therapies such as massage therapy, music therapy, relaxation techniques
• Socialization

The Goal of Hospice is to minimize Pain and at the same time maximize the Quality of Life of the individual. How we do this takes training, discipline, team work and cooperation.

The patient and family remain the center of our Plan of Care and are included in the decision making process. We value their input. Who else is better at knowing what their needs are than the patients themselves.

We believe that

• Pain is whatever the patient says it is
• Pain is present whenever the patient says it is
• Pain management will only work when the patient/family/caregiver understand and agree with the medication regime. We must respect the patient's values, preference and expressed needs.
• The pain regime needs to be simple
• The Palliative approach to pain management means that the least invasive route of administration should be used

     Dependence – a predictable consequence of long term opioid administration but can also occur with other drugs. It is a physiologic accommodation to the presence of the drug which can cause withdrawal on cessation. Withdrawal symptoms usually are suppressed by gradual withdrawal of the opioid.

     Addiction – true addiction is a psychological issue in which opioids actually worsen the quality of a person's life. Use of the drug actually becomes the focus of life for the addict. Multiple studies have proven that addiction is rare, occurring in less than 1% of patients using opioids for pain relief. (McCaffrey, 1999)  
 

PACE YOURSELF

Pacing

Take a break you need it!

• The pain stays manageable
• You are able to maintain a certain level of activity day after day. There is no need to take time off.
• Everyday you are able to accomplish something you want or need to do.

The Big Push

Forcing Yourself!

• Your pain increases significantly. Medication will need to be increased and your irritability will increase.
• You will be required to take time off to recover. The recovery process may be slow and depressing.
• You may have accomplished your goal but while you are recovering you cannot do much at all.

Pressure Sores

Problems – Pressure sores can cause:

• Pain
• Decreased mobility
• Infections

• Pressure or friction on the skin
• No change in position when a patient is either bedbound or chairbound
• Damp or wrinkled sheets
• Poor circulation
• Incontinence

• Do not massage the sore or the area around the sore
• Kept the sheets tight to prevent wrinkles
• Change position at least every 2 hours
• Change patient frequently if incontinent of urine or stool
• Wound care as ordered by your physician