Manage End-of-Life Symptoms Part 2 – Nursing Continue Education

End-of-life uncomfortable signs and symptoms: Part 2 Cont. 

Delirium and Agitation (Physical restraint may be needed to keep patient safe during periods of delirium or agitation, but avoid restraint use whenever possible due to it may exacerbate agitation)

• Delirium vs. Dementia (slower, more progressive debilitating effect on memory and function)
  • Delirium affects cognition, attention, the sleep-wake cycle, mood, and speech.
  • Delirium: Family members may state that the patient “just isn’t herself today” or “would never say such things normally.”
  • Common cause of delirium are opioids, dehydration, infections, hypoxia, nutritional deficiencies, renal failure, brain metastases, and endocrine abnormalities.
• Agitation
  • Haloperidol is the most effective medication. Haloperidol is considered as less sedating than lorazepam, also, lorazepam has proven ineffective in treating delirium
  • When pt reaches end-of-life, benzodiazepines and sedating neuroleptics are considered equally effective in controlling agitation.

Dyspnea (shortness of breath, breathlessness, or air hunger)

• At end-of-life dyspnea occurs in about:
  • 75% of heart failure patients (fluid builds and compresses lung tissue)
  • 20% to 70% of cancer patients (pleural effusions – fluid amasses in the pleural cavity)
  • 65% to 94% of patients with respiratory disease
• Opioids Commonly used to ease
  • Double effect: although decreasing respiratory drive is an adverse effect of morphine, giving morphine to the dying patient is acceptable under the double effect principle because the harmful effect isn’t intended but arises as an adverse effect of action taken to relieve pain.

Weakness and fatigue

• common chronic symptoms associated with cancer and other chronic disease
• help pt decide how active they prefer to be or which activities they can tolerate

Constipation (a bowel regimen should always accompany opioid therapy)

• due to medication r/t receiving opioids regularly, along with s/s such as abdominal pain, nausea and vomiting, and continued urge to defecate (with poor results)
• poor oral intake and inability to tolerate fluids
  • lead to dehydration
• lack of activity

Nausea and Vomiting

• common in earlier stages of chronic illness
• r/t chemotherapy treatment
• antiemetics symptoms management

To Be Cont. … …

Resource retrieved from http://www.AmericanNuseToday.com:

D’Arcy, Y. (2012) Managing end-of-life symptoms: For patients nearing death, relieving distressing symptoms is perhaps the most valuable contribution you can make.