ELNEC Core Module 3: Symptom Management

Outline:
Section 1: Introduction

About This Course

Learning Objectives

Section 2: Introduction to Symptom Management

Essential Elements

Symptoms and Suffering

Living with Chronic Lung Disease

Common Symptoms Within Serious Illnesses

Meet Alice

Summary

Section 3: Respiratory Symptoms

Dyspnea

Causes of Dyspnea

Subjective Report

Clinical Report

Pharmacologic Treatment of Dyspnea

Non-Pharmacologic Treatment of Dyspnea

Cough

Alice’s Dyspnea

Summary

Section 4: Gastrointestinal Symptoms

Anorexia and Cachexia

Causes of Anorexia and Cachexia

Assessment of Anorexia and Cachexia

Treatment of Anorexia and Cachexia

Constipation

Causes of Constipation

Assessment of Constipation

Treatment of Constipation

Additional Approaches

Diarrhea

Causes of Diarrhea

Assessment of Diarrhea

Treatment of Diarrhea

Nausea and Vomiting

Causes of Nausea and Vomiting

Assessment of Nausea and Vomiting

Symptom History

Pharmacologic Treatment of Nausea and Vomiting

Non-Drug Treatment of Nausea and Vomiting

Review

Summary

Section 5: Psychological Symptoms

Factors to Consider

Depression

Assessment of Depression

Suicide Assessment

Pharmacologic Interventions for Depression

Non-Pharmacologic Interventions for Depression

Anxiety

Assessment of Anxiety

Interventions for Anxiety

Posttraumatic Stress Disorder

PTSD and Serious Illness

Cognitive Changes

Causes of Cognitive Changes

Assessment of Cognitive Changes

Treatment of Cognitive Changes

Review

Summary

Section 6: General Symptoms

Fatigue

Pressure Injuries

Malignant Wounds

Assessment of Wounds

Treatment of Wounds

Lymphedema

Seizures

Sleep Disturbance

Unable to Self-Report

Review

Summary

Section 7: Conclusion

Course Summary

Course Contributors

Resources

References

The content for this course was written by The ELNEC Project Team.
The ELNEC Project, which began in 2000, is a collaboration between City of Hope, Duarte, CA and the American Association of Colleges of Nursing (AACN), Washington, DC. For more information about ELNEC, go to www.aacnnursing.org/ELNEC

The content for this course was revised by:
Constance Dahlin, MSN, ANP-BC, ACHPN®, FPCN, FAAN has focused her career within hospice and palliative care. She has experience in administration of programs, program development, curricula development, education of the interprofessional team, and clinical practice in the home, clinic, long term care setting, rehabilitation setting and the acute care setting.. Currently, she is faculty here at University of Maryland Baltimore PhD, Master of Science and Graduate Certificate in Palliative Care, a consultant to the Center to Advance Palliative Care (CAPC) in community-based care and education, co-director of the Palliative APP Externship, with a clinical practice as a palliative nurse practitioner at Salem Hospital and. She serves as national faculty for the End-of-Life Nursing Education Consortium (ELNEC), the American Hospital Association Circle of Life Committee, the Massachusetts Serious Illness Coalition Nursing Taskforce, and the Massachusetts Comprehensive Cancer Steering Committee. 

Ms. Dahlin authored several editions of the Palliative Nursing: Scope and Standards and Competencies for the Palliative and Hospice RN, and APRN.  She wrote the Hospice and Palliative APRN Professional Practice Guide and A Primer of Reimbursement, Billing, and Coding: Essential Information for the Hospice and Palliative APRN. She is coeditor of the Oxford University Press Advanced Practice Palliative Nursing 1st and 2nd editions. She referenced the 2004 first education of the National Consensus Project’s Clinical Practice Guidelines for Palliative Care and edited the 2009 second and third 2013 editions. 

Ms. Dahlin served on the Measurement Applications Partnership PAC/LTC Workgroup, the Measurement Applications Partnership Clinician Workgroup within the National Quality Forum and co-chaired the Massachusetts Comprehensive Cancer Control and Prevention Network Palliative Care Workgroup. Ms. Dahlin is a Fellow of Hospice and Palliative Nursing, a Fellow of the American Academy of Nursing, a 2005 Certified ACHPN APRN of the year, a 2016 recipient of a Sojourns Cambia Health Foundation Sojourns Leadership Scholar Award, a 2018 American Academy of Hospice and Palliative Medicine Visionary in Hospice and Palliative Medicine, the 2020 HPNA Distinguished Practice Award and the 2021 University of Maryland Baltimore Master of Science and Graduate Certificates in Palliative Care Teacher of the Year.  She completed her MSN in oncology nursing and her post-masters in adult primary care at the MGH Institute of Health Professions. She has authored peer reviewed articles, chapters and curricula and presented nationally and internationally.

Judith Paice, PhD, RN is the Director of the Cancer Pain Program in the Division of Hematology-Oncology and a Research Professor of Medicine, Northwestern University, Feinberg School of Medicine. She is also a member of the Robert H. Lurie Comprehensive Cancer Center.  Dr. Paice is presently a member of the NIH HEAL Initiative Multidisciplinary Working Group and has served as President of the American Pain Society and Secretary of the International Association for the Study of Pain. Currently a panel member of the NCCN Adult Cancer Pain Clinical Practice Guideline, much of Dr Paice’s clinical work has been in the relief of pain associated with cancer. She has traveled widely within six continents to educate health care professionals regarding cancer pain relief and palliative care.  Dr. Paice serves on the editorial board of the Journal of Pain, Journal of Pain and Symptom Management and Journal of Clinical Oncology and is the author of more than 170 scientific manuscripts. She was one of the original consultants in the End-of-Life Nursing Education Consortium (ELNEC) and has continued serving as a faculty member in this program. In 2018, Dr. Paice was named one of the 30 Visionaries in the field by the Academy of Hospice and Palliative Care.