Ross Jeanette S
University of Texas Health Science Center - University of Texas Health San Antonio, 7703 Floyd Curl Dr MSC 7875, San Antonio, TX 78229-3900.
FP Essent. 2020 Nov;498:11-20.
As the health status of patients living with multiple chronic conditions declines, these patients experience a variety of symptoms (eg, respiratory, gastrointestinal, psychological symptoms; overall symptoms of decline; and pain). Respiratory symptoms can include dyspnea, cough, and excessive upper respiratory tract secretions. Gastrointestinal symptoms can include nausea and vomiting, constipation, and malignant bowel obstruction. Overall symptoms include anorexia, cachexia, and fatigue. Psychological symptoms may manifest as depression, anxiety, or delirium. For patients with chronic pain and progressive disease, it is important to identify the etiology and type of pain (ie, visceral, somatic, neuropathic) because management differs. An evaluation of total pain should consider the various domains of suffering, including physical, psychological, and spiritual suffering. It is imperative to attempt to identify the underlying causes of the symptoms and address it if possible. It also is important to relieve symptoms using nonpharmacologic and pharmacologic approaches. In patients unable to self-report symptoms, family members and/or caregivers can provide insight into the condition of the patient.
随着患有多种慢性病的患者健康状况下降，这些患者会出现各种症状（如呼吸道、胃肠道、心理症状；整体衰退症状；以及疼痛）。呼吸道症状可包括呼吸困难、咳嗽和上呼吸道分泌物过多。胃肠道症状可包括恶心、呕吐、便秘和恶性肠梗阻。整体症状包括厌食、恶病质和疲劳。心理症状可能表现为抑郁、焦虑或谵妄。对于患有慢性疼痛和进行性疾病的患者，识别疼痛的病因和类型（即内脏性、躯体性、神经性）很重要，因为治疗方法不同。对总体疼痛的评估应考虑痛苦的各个方面，包括身体、心理和精神痛苦。必须尝试识别症状的潜在原因并尽可能加以解决。使用非药物和药物方法缓解症状也很重要。对于无法自我报告症状的患者，家庭成员和/或护理人员可以提供有关患者状况的见解。
