Hospice & Palliative Care · Nursing Continue Education

Manage End-of-Life Symptoms Part 3 – Nursing Continue Education

End-of-life uncomfortable signs and symptoms: Part 3 Cont. 

Poor Secretion Control:

  • Death Rattle” -noisy, rauling breathing results from movement of secretions that have pooled in the throat due to pt lacks the capacity to clear secretions
    • Suctioning – can cause discomfort and distress, leading to agitation and increased secretion production
    • Scopolamine patch place behind pt’s ear -help dry up secretions
    • IV or SubQ glycopyrrolate (Robinul)

Nutritional problems:

  • as death approaches, the body begins to shut down and nutritional needs decrease dramatically. at this time, consider offering the patient a favorite food if he or she can still swallow.
  • Starving to death? vs. reality
    • in reality, the body no longer requires nutrition and hunger is suppressed
    • for example, for most terminal patients, a feeding tube only provides liquids the body can no longer use, resulting in edema that can cause painful swelling of the extremities

Palliative Sedation vs. Euthanasia

  • the goal of palliative sedation is to relieve suffering, not hasten death.
  • don’t confuse palliative sedation with euthanasia, which implies the purposeful ending of pt’s life.
  • Palliative sedation medications:
    • IV or subQ
    • midazolam and barbiturates, alone or in combination
  • Palliative sedation should be supervised or provided by a palliative care specialist or other provider skilled in palliative sedation.

*** Palliative sedation is viewed as a last resort alternative for the palliation of any symptom that is truly refractory to standard treatment. It is appropriate when all other reasonable approaches to relieve symptom distress have been exhausted. However, it may cause moral distress for some clinicians, therefore an ethics consult is imperative when considering palliative sedation. When palliative sedation is employed, a written informed consent is required, and the sedating agent is titrated against apparent unconsciousness of the patient. ***

Educating and supporting patients and families: 

  • Providing education about the dying process and setting goals of care helps ensure the family members have input into their loved one’s care.
  • Discussing the goals of care gives healthcare providers a sense of how the family feels about specific therapies (such as opioids) and clarifies questions or misperceptions
  • Taking the time to teach families about the benefits of pain relief can make them more comfortable with treatment
  • Discussing the dying process can be helpful: consider opening the discussion by describing what occurs when someone dies, explain how apnea begins, mentioning that the patient will take shallower breaths and apneic periods with be more frequent as death nears

The day a person dies should be as important as the day of birth!

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.

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