Below are some, while certainly not all, emotions and situations you may find yourself coming into contact with, when taking care of a terminally ill client.
Anxiety and Fear - These are common feelings that clients may have, especially when first diagnosed with cancer. As time goes on, however, these feelings can remain as a client wonders what treatments they may be facing or how their quality of life may be affected. As a care provider, you can gently invite the person to talk about their fears and concerns. Listen carefully, don't judge, and decide together what the two of you can do together to help alleviate any fears.
Poor Appetite - A person with a poor or no appetite may eat much less than he/she normally would or not at all. Poor appetite can be caused by trouble swallowing, depression, pain, a changed sense of taste or smell, feeling full, tumour growth, dehydration, chemotherapy, nausea, or vomiting. Most often poor appetite is a short term problem. As a care provider, it is important to watch for signs of lack of interest in food, refusing to eat favourite foods, or weight loss. Things you can do to help with poor appetite is giving your client 6 to 8 small meals and snacks a day, offer starchy foods (such as bread, pasta or potatoes) with high protein foods (fish, chicken, meats, turkey, eggs, cheeses, milk, tofu, nuts, peanut butter, yogurt, peas, and beans), keep cool drinks and juices by client, offer fruit smoothies or milkshakes, don't blame yourself if the client doesn't eat, and sometimes just offering company is enough.
Blood Counts - The haemoglobin percentage measures the body's ability to carry oxygen. A normal haemoglobin range is about 14.5 to 18 for men and 12-16 for women. Most people still do well with a haemoglobin count as low as 10. A low haemoglobin level is called anemia. The white blood cell count measures your body's ability to fight infection. A low white blood cell count may put you at risk for infection, while a high white cell count may be a sign an infection has already been contracted. A platelet count looks at the cells that help your blood to clot. Dangerous bleeding can occur if the platelet count drops too low. As a care provider, if you know that your client is dealing with one of these conditions, aside from providing your normal level of care, be aware of signs of confusion, faintness or dizziness.
Confusion - When the thought process is disturbed or the client has trouble thinking and focusing, he/she may be confused. There can be many causes of confusion including low blood sugar, infection, high fever, tumour spread to the brain, cancer in the fluid surrounding the brain, lack of oxygen to the brain, too much calcium in the blood, intense pain or too much pain medicine. If your client is experiencing bouts of confusion, it may be beneficial to go to a doctor's appointment with them so you can describe the client's problems and remember instructions. You can help focus your client's attention by gently touching their hand and facing them when talking. In cases of extreme confusion, remind the client who you are. It also helps to keep a clock and a calendar where the client can see them.
Depression - Some degree of depression is very common when a client and their family is facing cancer. Sadness and grief are normal, as well as a range of other emotions. But when these feelings last a long time or get in the way of daily activities, there is cause for concern. It is important to be understanding and supportive, but not condescending or telling someone to 'cheer up'. Do not try to reason with or belittle the client's feelings, as to them these feelings are very real and uncontrollable. Another suggestion is to attempt to engage the person into activities he/she enjoys.
Falls - A person who is unsteady on his feet, a little confused, or just weak is at high risk for falling. A person who has these problems is likely to fall while trying to get out of bed, in the toilet or commode, slip in the bathtub or shower, or tire out and fall when walking. To help, encourage the client to sit up in bed first, on the edge for a minute or two, to wake up and clear their head. If a client is unsteady you can assist them in walking. Using mats or non-slip stickers in the bathtub can help avoid falls as well. Ensure that walking paths are clear and tape the edges of rugs to the floor.
Fever - Fever is a body temperature higher than 100.5 F (when taken by mouth) that lasts for a day or more. Fever is usually caused by an infection. Infections can be viral, bacterial or fungal. Other causes of fever include inflammatory illness, drug reactions or tumour growth. People going through chemotherapy are more prone to have infections because they have lower numbers of white blood cells needed to fight them. As a care provider, it is important to watch for shaking chills and to check the fever once they stop. Encourage visitors who may have a fever or the flu to visit the client by phone until they are well again, due to lowered white blood cell count. Offer the client extra fluids and snacks, and ensure the client is taking their medications on time.
Hair Loss - Some cancer treatments will cause clients to lose some or all of their hair, most often in clumps during shampooing or brushing. Sometimes, clumps of hair are found on a pillow in the morning. This can be a very upsetting thing, for men and women alike. Hair loss can happen when chemotherapy drugs move throughout the body to kill cancer cells. Some of these drugs damage hair follicles, causing the hair to fall out. Hair loss can be hard to predict. Not everyone will experience it. Sometimes as well, radiation therapy to the head will cause hair loss and depending on the dose, hair does not grow back as it was before. Should this happen to a client, the best thing to do is be supportive, encouraging, and a sympathetic ear for someone who needs to talk.
Nausea and Vomiting - Nausea is having a sick or queasy feeling in your stomach, and vomiting is throwing up food or liquid in your stomach. This can be caused by eating something that disagrees with you, bacteria in food, infections, or radiation and chemotherapy treatments. Cancer alone can cause nausea and vomiting. If a client feels nauseated, offer to make meals that do not have a smell, and use a kitchen vent to reduce smells. Ensure the client does not become dehydrated and keep an eye on their weight. Watch your client for dizziness, weakness or confusion as well.
Seizures - A seizure is an uncontrolled movement of the muscles. Seizures in cancer patients can be caused by high fevers, head injury, serious infections of the fluid around the spine and brain, imbalance in body chemistry and tumour growth in the spine or brain. It is important if a seizure happens to keep the client safe. If a seizure starts while a client is in a chair or on the bed, cradle the client to keep him/her from falling on the floor. Stay with the client during the entire seizure and remain calm. Most seizures last less than five minutes. If a client is laying on their back, turn them to their side to help avoid further complications. Once the seizure is over, cover the client with a blanket and allow them to rest.
Sleep problems - Sleeping problems can be defined as a change in usual sleep habits. People who are getting treatment for cancer may get tired more easily and need to sleep more than usual. Sometimes the opposite problem occurs and people have trouble sleeping due to pain, anxiety, worry, depression, night sweats, or side effects of treatment and prescriptions. To remedy this, try to ensure the room is as quiet and comfortable as possible. Sometimes a light bedtime snack can be helpful. Be sure to make a note if the client appears to be confused during the night.
While every case is different and may offer a unique set of challenges to deal with, knowing some of the basics and being aware of the specialized care can ensure your client dealing with cancer is as comfortable as possible at home, and entrusts their home care to you.