"Professionals seldom appreciate how
much fear and anxiety complicate the
learning of tasks [for caregivers]. Learn-
ing how to operate a feeding tube or
change a dressing or inject a medication
is hard enough for a layperson; caregivers
learn how to perform these procedures
for the first time on a person they love.
Fearful of making a mistake or simply
upset by the idea of having to perform
unaccustomed and unpleasant tasks,
caregivers may resist or fail, or persist at
great emotional cost."
- Carol Levine, Author
- Adapted from Always on Call, Edited by Carol Levine

---

S Y M P T O M M A N A G E M E N T A T H O M E
There are a great many symptoms that your loved one
may experience throughout the course of illness. This
chapter will give you some general information and
guidelines about how to manage some of the most com-
mon symptoms:
s Pain
s Fatigue
s Dyspnea
s Gastrointestinal Complications
s Skin Problems
s Psychological Complications
You should always check with the doctor prior to treating
the patient in order to ensure proper care of his/her prob-
lem. Space is provided at the end of each section for you
to attach or write in any specific instructions given by the
patient's doctor.
25

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P A I N
The biggest fear of chronically ill patients and
Pain can cause people to feel depressed and anxious, just
their families is that the patient will suffer with
as depression and anxiety can make pain worse. Because
unrelieved pain. Most injuries, surgical proce-
many of the signs of pain are the same as those of anxi-
dures, and chronic illnesses are associated with
ety and depression, you need to know what is causing
some degree of pain. The experience of pain is
these symptoms and to seek treatment for them in order
subjective, and can be affected by the severity
to stop further suffering. All types of pain can be treated
of the underlying illness or injury; psychological
safely and effectively using many types of treatments,
factors, such as individual coping styles and
including medication and non-drug treatments. Pain
emotional support; and other factors. Because
treatment needs to be tailored to the individual. What
pain is an individual experience, it is impossible
works for one person may not work for the next. Pain can
to know what another's pain feels like. Many
be treated through the use of one or a combination of the
people do not tell others how much pain they
following:
feel for a variety of reasons: they believe that
s drug therapies (e.g. anti-inflammatory drugs, opioids,
they are not supposed to have pain, they think
antidepressants, anticonvulsants)
that pain is a sign of weakness, or they assume
s psychological approaches (e.g. relaxation training, dis-
that nothing can be done. Living with pain can
traction, biofeedback)
exhaust a person and ruin quality of life. It is
s rehabilitation therapies (e.g. physical therapy, occupa-
important for you to recognize if the patient is
tional therapy)
in pain in order to promote appropriate pain
s anesthetic treatments (e.g. nerve blocks, spinal cord
management.
stimulation).
Your loved one may be in pain if he/she:
A word about pain medication:
Acetaminophen and nonsteroidal anti-inflammatory drugs
s has decreased appetite
(NSAIDs) ­ These drugs are used to treat mild pain. They are best
s has lost interest in regular activities
known as over-the-counter medications and include aspirin, ibupro-
s is crying and upset about discomfort
fen,and acetaminophen. However, some NSAIDs require a prescrip -
tion.
s grimaces or winces when moving
Opioids (also called narcotics) ­ Drugs that are used to treat mod-
s stays in bed and doesn't get dressed
erate to severe pain and require a prescription. These include mor-
s has difficulty sleeping
phine, methadone, oxycodone, and hydrocodone.
s is tense and tries to avoid movement
Adjuvant analgesics - Drugs that are used primarily to treat condi-
tions other than pain but can relieve some painful conditions. These
include drugs in many classes, such as antidepressants, anticonvul-
sants, anesthetics, and corticosteroids.
26

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The Facts About Pain
MYTH: "The patient will develop a tolerance to
Medication
his/her medication and will have to keep taking
more and more until he/she is immune to it and it
Many patients do not follow their pain manage-
doesn't work anymore."
ment regimens due to misconceptions about
FACT: Tolerance to opioid drugs occurs but is seldom a
tolerance, physical dependence, and addiction
clinical problem. Tolerance means that taking the drug
to pain medications. You, the caregiver, must
changes the body in such a way that the drug loses its
effect over time. Most patients' doses are gradually
know the facts about pain medicines so that
increased until pain relief is obtained, then they stabilize
you can help your loved one achieve the best
at this dose for a long period of time. If doses need to be
possible pain relief. Here are the FACTS about
increased because pain returns, it is more commonly due
some common myths you've probably heard:
to disease factors than to tolerance.
MYTH: "Pain medication should be saved and used
MYTH: "If the patient takes narcotic med-
only when pain is severe."
ications, he/she will become addicted."
FACT: Pain medication should be given on a regular
FACT: Addiction is characterized by the compul-
schedule so that there is a stable amount of medicine in
sive use of drugs for their psychological effects;
the body to keep the pain away. By taking medication
the drugs are causing harm to the person, but
before the pain becomes unbearable, the patient can get
are still taken. It is rare for pain patients with
better relief with lower doses and fewer side effects.
no history of substance abuse to become
MYTH: "The patient will not be him/herself on the
addicted to pain medication--including opioid
medication and will become a zombie."
drugs, such as morphine. Many people confuse
physical dependence, which is the occurrence of
FACT: Although opioids can make people sleepy and cloud
withdrawal when the drug is stopped, with
their thinking, this side effect is usually temporary. Long-
addiction.
term therapy is generally associated with normal thinking.
Most patients can take opioid drugs for a long period of
MYTH: "If the patient no longer needs the
time and be mentally normal. Patients who have been
medication, he/she will go through severe
stabilized on opioid therapy and are clearheaded can
withdrawal when trying to stop it."
drive, work, and do whatever else their health allows.
FACT: Withdrawal is a physical phenomenon
that means that the body has adapted to the
drug in such a way that a `rebound' occurs
when the drug is suddenly stopped. All people
who take opioids for a period of time can have
this withdrawal syndrome if the drug is stopped
or the dose is suddenly lowered. This can be
prevented by slowly tapering use of a drug over
time. Possibly having withdrawal is not the
same as being addicted and is usually no prob-
lem at all.
27

---

What you can do to help
When to call the doctor:
s Encourage the patient to take pain medica-
v If the patient is experiencing severe pain
tion exactly as prescribed.
v If there is an adverse reaction to pain medication
s Assess the patient's pain using a pain rating
v If the patient continues to experience pain between
scheduled doses of long-acting pain medication
scale from 0 (no pain) to 10 (worst pain
v If the patient is unable to get up and walk due to pain
imaginable) so that you know their pain level
v If the patient is unable to sleep due to pain
and can communicate this to the doctor.
v If the patient is crying and upset about feeling pain
s Make sure the patient has at least a 3-day
v If the patient avoids movement or tenses muscles
supply of pain medicine and call for a new
when moving
prescription before the last dose of medica-
v If there is decreased appetite due to pain
tion is given.
v If there is less desire to engage in normal activities
due to pain
s Help the patient keep a journal of his/her
pain in order to identify factors that make
the pain better or worse (Pain Journal provided
Before you call/see the doctor
at the end of this section).
Before calling, you should make sure that you or the
s Massage painful areas, if the patient says
patient know the answers to certain questions that may
that this helps and the doctor has not
be asked about your loved one's pain. Preparing the
warned against it.
answers before you call can better help the health care
s
team determine the cause, severity, and proper treatment
Assist the patient with lifting or moving
for the problem.
heavy objects.
s Encourage the patient to use deep breathing
s When did the pain start? / Is this a new pain?
and relaxation exercises (see "Relaxation"
s How long has the patient had this pain?
s
section for instructions).
Exactly where is the pain located in the body?
s What is the quality of the pain (what does it feel like)?
s Involve the patient in other activities to dis-
s On a scale of 0 to 10 (with 0 being no pain, and 10
tract them, such as watching a movie, using
being the worst pain imaginable), how would the
the computer, playing a game, or reading.
patient currently rate his/her pain?
s When does the pain occur?
s Is there anything that makes the pain better?
s Is there anything that makes the pain worse?
s Is the pain interfering with other areas of the patient's
life?
s What medications is the patient currently taking for the
pain?
28

---

Special instructions
Helpful Websites for Pain:
www.stoppain.org
www.pain.com
www.theacpa.org
www.painandhealth.org
www.aapainmanage.org
www.webmd.com
29

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F A T I G U E
Symptoms of fatigue
s Generalized (whole body) weakness or tiredness
s Diminished energy disproportionate to activity
s Sleep abnormalities
s Diminished motivation or interest in activities
s Diminished activity associated with lower physical or
intellectual performance (eg. lack of focus, short atten-
tion span, memory problems)
s Irritability, impatience, sadness, or other changes in
Fatigue is a feeling of weariness, tiredness, or
mood
lack of energy that varies in degree, frequency,
Treatment of fatigue
and duration. Everyone has experienced nor-
While rest may lessen fatigue associated with medical ill-
mal/acute fatigue, which improves with rest or
ness, it does not erase it. Although patients with chronic
sleep, exercise, and a balanced diet. Acute
diseases and fatigue may need rest during the day, they
fatigue may be caused by excessive physical
should recognize that these activities will not eliminate
activity, lack of exercise, insufficient rest or
the problem. The treatment of fatigue includes identifying
sleep, poor diet, dehydration, increase in activi-
and managing the underlying cause and using a variety of
ty, or other environmental factors. Chronic
interventions, including medication; education; exercise;
fatigue associated with a disease or treatment
sleep hygiene; stress management, and nutrition.
of a disease does not improve with rest and can
seriously affect a person's ability to function.
Fatigue in chronic illness is a common problem
The Six "E's" to Manage Fatigue
and should not be viewed as laziness or depres-
Evaluation
sion. Chronic fatigue may be related to numer-
Keeping a daily journal of fatigue can provide invaluable
ous illnesses, such as cancer;AIDS; heart, lung
information for the patient, you, and the health care team.
or kidney impairment; sickle cell disease; and
Patterns of fatigue, energy levels, and activities that
many other medical conditions. Fatigue can
increase or decrease exhaustion are all important. This
accompany psychological symptoms, such as
information can help professionals identify the cause or
depression, result from the use of some medica-
aggravating situations and evaluate the best treatment
tions, or be associated with chemotherapy and
approach for the patient. A Fatigue Journal is provided at
radiation therapy.
the end of this section.
30

---

Energy Conservation
Easing Stress
Energy conservation involves the use of plan-
Anxiety, coping with a chronic illness or its treatment, and
ning, prioritizing, delegating, and pacing in
sleep disturbances may contribute to fatigue. Stress man-
order to store up energy, which can then be
agement techniques, such as relaxation therapy, hypnosis,
used for more important activities. Help the
guided imagery, or distraction, can reduce worry and dis-
patient identify high-energy activities (e.g.
tress. Referral to a psychologist for counseling and train-
bathing, dressing) and tasks which contribute to
ing in stress management may be warranted in some
his/her fatigue. Try to find ways to help the
patients. See the "Stress Management" section or Fact
patient make activities simpler and less tiring.
Sheet for more information.
Also, encourage the patient to plan and pace
activities around times when he/she has more
Eating Well
energy.
A balanced diet that combines adequate calorie intake
(grains, green vegetables, legumes, and proteins) can help
Exercise
maintain energy levels. Adequate fluid intake can prevent
Excessive bed rest can promote weakness or
dehydration and hypotension, which can intensify fatigue
decreased energy levels and eventually increase
fatigue. Mild to moderate exercise, such as
symptoms. The patient's diet should be tailored to his/her
walking and stretching, can relieve fatigue
dietary needs or restrictions, as indicated by the doctor or
symptoms, increase functioning, and gently
nutritionist.
energize both healthy people and those with
What you can do to help
chronic diseases. Light to moderate exercise, as
s
recommended by a physician, should be tailored
Encourage the patient to discuss his/her fatigue (tired-
to the individual according to age, physical and
ness).
medical condition. Exercise should begin grad-
s Make sure that the health care team is aware of the
ually, several days a week, and not be per-
patient's fatigue.
formed to the point of exhaustion.
s Schedule tasks according to their importance.
s Promote resting between high-energy activities.
Energy Restoration
s Plan tasks more efficiently so they can be easily accom-
Remaining active may maintain energy levels or
plished.
increase the patient's ability to do more neces-
s Encourage the patient to get up or move slowly to
sary tasks. Some patients also find that distrac-
avoid dizziness or falls.
tion strategies, such as listening to music,
s Serve small snacks as well as balanced meals high in
watching TV, playing cards, or other cognitive
carbohydrates (pasta, bread, fruit, and potatoes).
techniques help get rid of mental fatigue and
restore mental activity.
31

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Helpful Websites for Fatigue:
v www.stoppain.org
v www.cancerfatigue.org
v www.cancercareinc.org
v cancernet.nci.nih.gov
s Make sure the patient drinks plenty of fluids
(6-8 glasses per day or as much as the doctor
Special instructions
allows).
s Help the patient with difficult or high-energy
tasks.
s Encourage the patient to do some light exer-
cise every day.
s Keep the patient as active as possible during
the day to foster easier sleep at night.
s Schedule regular times to rest and sleep to
help the patient's body develop a routine.
s Encourage rest when tired by going to sleep
earlier, sleeping later, and taking naps.
s Assess anxiety levels and help calm the
patient (see Relaxation Fact Sheet) if anxiety
is interrupting sleep.
When to call the doctor:
v If the patient is experiencing severe or fre-
quent dizziness
v If the patient is unable to be awakened
v If the patient experiences confusion
v If the patient experiences ringing in the ears
v If the patient feels pounding in the head
v If the patient stays in bed for more than 24
hours without getting up
v If fatigue is worsening
32

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D I F F I C U L T Y B R E A T H I N G ( D Y S P N E A )
It is important to recognize that while shortness of breath
can cause anxiety, anxiety can also cause and worsen
breathing difficulties. However, there are some things
that you can do to help the patient avoid this cycle.
Treatments for dyspnea
Medications:
s Antibiotics ­ Fight infections that may cause breathing
problems
Dyspnea, or shortness of breath, is the unpleas-
s Diuretics ­ Rid the body of excess fluids
ant sensation of having difficulty breathing. It
s Bronchodilators ­ Open up air passages in the lungs
can occur for many different reasons, such as
s Steroids ­ Reduce inflammation, which opens air pas-
when not enough oxygen is getting to the body
sages
because of lung disease. When severe, it is a
s Opioids ­ Can directly lessen the sensation of breath-
frightening experience for both the patient and
lessness
the caregiver.
s Anxiolytics ­ Calm patients and slow their breathing
Non-Drug Treatments:
Difficulty breathing can be caused or
worsened by
s Relaxation exercises ­ Help reduce emotional and phys-
s chronic lung disorders
ical stress and tension (see "Learning How to Relax"
s airway obstruction
section for details).
s pneumonia
s Deep breathing techniques ­ Promote relaxation.
s pain
s Oxygen ­ A machine supplies extra oxygen to the body,
s stress/anxiety
which helps the patient breathe easier.
s advanced, progressive illness
s Positioning ­ Sitting upright allows gravity to assist the
s tumor
patient in breathing.
s fluid in the lungs
s Increased room air ventilation ­ Good air circulation
s certain chemotherapy or radiation treatments
makes it easier for patients to breathe.
s Psychosocial support ­ Addresses the impact of anxiety
and stress on breathing problems.
33

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When to call the doctor:
v If there is labored or difficulty breathing
v If there is chest pain
v If the skin is pale or bluish
v If the skin feels cold or clammy
v If the patient has a fever
v If nostrils flare while breathing
v If there is wheezing
v If there is thick, yellow, green, and/or bloody sputum
v If the patient becomes confused
What you can do to help
s Remain calm.
s Stay with the patient and offer reassurance.
Helpful Websites for Dyspnea:
s Maintain bed rest for the patient.
v www.stoppain.org
s Raise the head of the bed or add pillows to
v www.cancerfatigue.org
an upright position.
v www.cancercareinc.org
s Promote air circulation in the room (use of
v cancernet.nci.nih.gov
fan or air conditioning).
s Use a fan to create a light breeze in the face
of the patient.
Special instructions
s Encourage deep breathing (see "Learning
How to Relax" section for breathing exercis-
es).
s Offer prescribed medication.
s Maintain prescribed oxygen.
s Use room humidifier or vaporizer to help
loosen secretions, if necessary.
34

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G A S T R O I N T E S T I N A L S Y M P T O M S
What you can do to help
Nausea/Vomiting
s Encourage the patient to take prescribed anti-nausea
medication
s Fix the patient frequent, light meals throughout the day
s Serve foods cool or at room temperature
s Avoid fried foods, dairy products, and acidic foods
(fruit, juice, and vinegar)
s Stay away from spicy foods; stick to bland foods, such
Gastrointestinal symptoms include such prob-
as dry crackers
lems as nausea (feeling queasy or sick to one's
s Make sure the patient's mouth is kept clean
stomach), vomiting (throwing up), constipation
s Offer chewing gum or hard candy
or diarrhea, anorexia (loss of appetite), and
s Take the patient outside or open a window for fresh air
cachexia (severe weight loss). These difficulties
s Encourage rest and relaxation
can be caused by a number of illnesses, treat-
s Make sure the patient drinks enough clear liquids,
ments, and medications, including:
sipped slowly, to prevent dehydration
s Avoid unpleasant or strong odors
s cancer, AIDS, and other diseases
s Distract the patient with music, television, or other
s radiation therapy
activities
s dehydration
s chemotherapy
When to call the doctor for Nausea and Vomiting:
s certain foods
v If there is blood or material that looks like coffee
s opioids, antibiotics, and other drugs
grounds in the vomit
s lactose (milk) intolerance
v If vomit shoots out for a distance (projectile vomiting)
s emotional distress and anxiety
v If two doses of prescribed medications are not taken
s surgery
or kept down because of nausea or vomiting
s taste changes
v If the patient cannot keep liquids or food down
v If weakness or dizziness occur
v If severe stomach pains occur with vomiting
35

---

Diarrhea
s Give medicine for diarrhea as directed by the doctor
s Replace lost fluids and nutrients by offering clear liq-
uids (clear juices, water, broth), often and in-between
meals (2-3 quarts per day)
s Serve foods low in fiber and high in potassium and pro-
tein (eggs, bananas, applesauce, mashed potatoes, rice,
and dry toast)
s Serve many small meals throughout the day rather than
Constipation
3 big meals
s Discuss the use of laxatives and stool soften-
s Avoid serving foods that may increase bloating (veg-
ers with the doctor and follow a regular
etables, beans, fruits)
schedule as directed
s Avoid serving fatty or acidic foods (fatty meat, fried
s If the doctor agrees, give the patient foods
food, spicy food)
high in fiber (whole grain cereal and bread,
s Limit caffeine intake (coffee, tea, soda with caffeine,
dried fruit, nuts, beans, and raw fruits and
and chocolate)
vegetables)
s Avoid serving dairy or milk products
s Make sure the patient drinks enough liquids
When to call the doctor for Diarrhea:
(up to 6-8 glasses per day)
v If the patient is losing a lot of fluid from severe
s Offer prune juice, hot lemon water, tea, or
diarrhea
coffee, which may stimulate the bowels
v If there is blood in the diarrhea
s Encourage daily exercise, such as walking (in
v If diarrhea is oily in the toilet
keeping with the doctor's advice)
v If there is a fever
When to call the doctor for Constipation:
v If the patient does not drink any liquids for
v If the patient has not had a bowel
more than 2 days
movement in many days
v If constipation occurs with severe
abdominal pain
v If constipation worsens and is followed by
vomiting
36

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When to call the doctor for Appetite/Weight Loss:
v If the patient reduces normal food intake for a long
time
v If the patient loses 5 pounds or more in a short time
v If there is pain with chewing and/or swallowing
v If the patient experiences dizziness upon standing
v If the patient does not urinate for an entire day, or
does not move the bowels for many days
Loss of Appetite/Weight Loss
Helpful Websites for GI Symptoms:
s Do not force feed the patient
v www.cdc.gov
s Do not get angry if the patient does not
v www.healthanswers.com
want to eat
v www.medicinenet.com
s Prepare familiar favorite foods
v www.stayhealthy.com
s Try light exercise or walking before meals
s Encourage eating meals at the table with
Special instructions
others
s Serve meals over a prolonged period of time
in a relaxed environment
s Place meals on smaller plates with smaller
servings more frequently
s Cover up unpleasant odors
s Serve a glass of wine before meals to stimu-
late appetite
s Offer frequent, high protein, high calorie
snacks (pudding, ice cream, milk shakes)
s Try new spices or flavorings for foods
s Prevent early feelings of fullness by: serving
beverages between meals, not with meals,
eating slowly, and avoiding too many
vegetables and carbonated drinks
37

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S K I N P R O B L E M S
s Signs and symptoms:
h red areas on the skin that do not go away when
pressure is removed
h cracked, blistered, scaly or broken skin
h an open sore involving skin surface or invading deep-
er, underlying tissue
h yellowish colored stains on clothing or sheets
h pain at pressure points
Ulcers - a crater-like lesion on the skin.
s Usually caused by inflammation or infection of the
area, or an underlying condition that may affect the
There are a number of skin symptoms that can
skin's ability to heal.
accompany diseases like cancer, AIDS, sickle cell
Edema - swelling of the skin that is caused by water and
disease, and other illnesses. Such skin prob-
salt retention.
lems include dryness, rash, itching, sores, ulcers,
s Can occur from certain medications; heart, liver, or kid-
and swelling. It is important for you to be
ney failure; malnutrition; and obstruction of veins or
aware of skin problems so that they can be
lymph nodes.
treated as quickly as possible in order to reduce
s Signs and symptoms:
discomfort and the risk of infection.
h swelling of feet and lower legs when sitting in a
chair or walking
Common skin problems
h feeling of tightness in the hands when making a fist
Pressure Sores - blisters or breaks in the skin
h swollen or distended abdomen
caused when the body's weight stops the flow
Itching - the desire to rub or scratch the skin
of blood to a certain area, causing a breakdown
s Can be the result of dryness, allergies, and side effects
in the skin.
of medications or treatments.
s Most likely to affect patients who are bedrid-
Rash - bumpy, red, itchy skin.
den, low weight, malnourished, or dehydrat-
s Commonly caused by an allergy, irritation, radiation
ed.
therapy, or certain infections.
s Usually occur in bony areas, such as the
Dryness ­ rough, flaky, red, sometimes painful skin due
to a lack of water or oil in the layers of the skin.
head, elbows, heels, hips, shoulders, and tail-
s Can be caused by dehydration, cold weather, heat, and
bone.
side effects of treatments (such as chemotherapy and
s Sores are made worse when the patient rubs
radiation).
against his/her sheets.
38

---

What you can do to help
Itching/Rash
s Suggest bathing with cool water
Pressure Sores
s Add baking soda to bath water
s Keep skin dry and clean
s Apply a cool moist cloth to itchy areas
s Check skin daily for pressure sores and other
s Wash sheets and towels in a mild laundry soap and
skin irritations
change daily
s Try to turn a bedridden person every few
s Avoid harsh laundry detergents
hours (or as often as possible), alternating
s Apply medications prescribed by the doctor for skin irri-
positions.
tations
s Encourage the patient to get out of bed as
Dryness
much as possible.
s
s
Never leave the patient lying or sitting in wet
Add mineral or baby oil to a warm bath
clothes or bedding.
s Apply moisturizers
s Make sure the bedding is not wrinkled or irri-
s Make sure the patient drinks enough water (8-10
tating the patient's skin.
glasses per day)
s Promote a balanced nutritious diet, high in
s Prevent dryness by not scrubbing skin while bathing
protein (tuna, chicken, cheese).
and gently patting skin dry
s Do not open or pop blisters.
s Put dry clean gauze on any open areas.
When to call the doctor:
Ulcers
v If you see pressure sores (cracked, scaly, blistered,
s The skin area should be kept clean and
broken skin)
observed for signs of infection (pain, redness,
v If a pressure sore is getting larger
drainage that looks like pus).
v If a cut becomes very red, sore, or swollen
s Follow treatment instructions from the doc-
v If skin gets very rough, red, or painful
tor, which may include wet dressings and
v If a rash or hives appear
topical antibiotics to control infection in open
v If pus comes out of an opening or cut
ulcers.
v If severe itching lasts more than a few days
Edema
v If a rash becomes worse after applying ointment
s Keep feet elevated when lying in bed or sit-
or cream
ting
v If swelling spreads up legs or arms
s Take medication, and restrict fluids or salt
v If the patient's belly becomes swollen
intake, as prescribed by the doctor
39

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Helpful Websites for Skin Problems:
v www.cdc.gov
v www.healthanswers.com
v www.medicinenet.com
v www.stayhealthy.com
Special instructions
Before you call/see the doctor
Before calling, you should make sure that you
or the patient know the answers to certain
questions that will probably be asked about
your loved one's skin condition. Preparing the
answers before you call can better help the
health care team determine the cause, severity,
and proper treatment for the problem.
s Exactly where is the problem located on the
patient's body?
s When did you first notice the problem?
s Has the irritation changed in appearance
since its onset?
s Does the irritation appear to be getting bet-
ter or worse?
s Can you identify anything that could have
caused the problem (allergy to food, new
detergent or soap, new medication)?
s Is there anything that helps relieve the dis-
comfort?
s Is there anything that makes the irritation
worse?
s What medications is the patient currently
taking?
40

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P S Y C H O L O G I C A L C O M P L I C A T I O N S
s Loss of interest or pleasure in ordinary activities
s Sleep problems (falling asleep, insomnia, getting up
very early in the morning, or excessive sleeping)
s Loss of appetite or overeating
s Tearfulness or excessive crying
s Problems concentrating, paying attention, remember-
ing, or making decisions
s Irritability
s Uncharacteristic withdrawal from others
Living with a chronic illness may be associated
s Thoughts of suicide or suicide attempts
with intense feelings of fear, worry, sadness, and
v Call the doctor if these symptoms last for two
grief. It is normal for you and the patient to
weeks or more, or if they are severe enough to
experience such emotions. However, over-
interfere with normal functioning.
whelming anxiety or depression that does not
Anxiety
go away is a psychological problem, and may
s Verbal expressions of anxiety, nervousness, panic or
require treatment. Clinical depression and anxi-
feeling like something terrible is going to happen
ety can be acute/reactive, meaning that they
s Verbal denial of obvious tension or anxiety
happen as a response to coping with a diagno-
s Difficulty solving problems
sis, illness, treatment, and prognosis. They can
s Muscle tension
also be chronic or pre-existing problems that
s Trembling and shaking
are worsened by the illness. Whatever the
s Difficulty breathing
cause, anxiety and depression are treatable con-
s Upset stomach
ditions. It is important to be aware of such psy-
s Sweaty palms
chological problems so that you know when or
s Racing heart
if they need to be treated by a doctor.
s Headaches
s Gets angry easily
Signs and symptoms
Depression
s Persistent sadness or feelings of guilt, worth-
lessness, hopelessness, and helplessness
s Tiredness or decrease in energy
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What you can do to help
When to call the doctor:
s Let your loved one express his/her feelings.
v If the patient expresses severe anxiety for several days
s Encourage the patient to identify any con-
v If the patient is trembling, shaking, or twitching
crete causes for the feelings.
v If the patient has a rapid pulse or heart rate
s Actively listen and try to understand what
v If the patient experiences feelings of dread or appre-
the patient is feeling.
hension for several days
s Provide support and encouragement.
v If the patient has serious problems falling or staying
s Make sure the patient knows that it is nor-
asleep for several days
mal for him/her to experience these feelings.
v If the patient has mood swings that cannot be con-
s Encourage the patient to participate in an
trolled
exercise regimen.
v If the patient talks about suicide (killing him/herself)
s Encourage the patient to speak to a profes-
v If the patient cannot eat or sleep or feels uninterested
sional counselor or therapist who has experi-
in activities of daily living for several days
ence with chronic illness.
s Promote the use of relaxation techniques
See Appendix B for listings of mental health organizations
(see "Relaxation" section).
that can give you more information and referrals to men-
s Recognize the signs (above) of psychological
tal health professionals or support groups in your area.
symptoms so that you know when it is nec-
essary to call the doctor.
Special instructions
s Encourage the patient to take anti-anxiety or
antidepressant medications as prescribed by
the doctor.
DO NOT...
s Force the patient to talk if he/she is not
ready.
s Tell the patient how he/she "should" feel.
s Assume that it is your fault if the patient is
feeling depressed.
s Feel that you must cheer the person up in
order to be helpful.
s Try to reason with the patient or talk him/her
out of how he/she is feeling.
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