disease and palliative 2 Flashcards
Nutrition and fluids
Most patients stop eating as they deteriorate. Subcutaneous fluids replace IV fluids. It is important to address the family’s concerns with food
What does food and eating mean in
society? end of life
Eating is associated with health. People come together to eat: it symbolises caring, loving, socialising: your first date, Christmas, Easter. To lose this is threatening to patients and their carers.
food and eating with patients and carers end of life
Sometimes patients eat just to make their families feel better even though it makes them feel worse. We need to let the families find another way of showing their caring.
Help with communicating to
the family.
food and eating
All dying patients lose their interest in eating in the
days to weeks leading up to death, this is the body’s
signal that death is coming.
Giving them extra food/ liquid will not improve their
living, it will only prolong their dying.
We will give him good mouth care so that his mouth
is kept moist.
If you would like to help with this, we can show you
how to moisten mouth swabs, and keep his mouth
and lips moist.
What else can you say? end of life food
Your relative is not dying of thirst or starvation. She is
dying from the disease.
She will not suffer. We will do everything possible to
keep her comfortable.
Withholding fluids end of life
if patients are kept on s/c or IV fluids, they have more secretions and this can make their breathing more difficult. It can also make their ascites or pulmonary oedema worse. Evidence has shown that patients who have fluids withheld do not die more quickly
Cessation of oral meds
An example of meds that can be stopped are
hypoglycaemics (patients are no longer
eating); anti-hypertensives (hypotensive,
anyway).
The question is: are these medications futile?
E.g. if a patient has epilepsy, we don’t want
them to have seizures in the terminal phase: IV
or s/c anti-epileptic drugs would be
appropriate.
Sometimes patients even continue with
intravenous antibiotics in the terminal phase:
an example was a patient who had an
abscess in his abdomen and the antibiotic was
keeping it at a manageable size for pain relief.
Communication tips
“Why can’t you just put us all out of our misery?”
This question could be asked by patients or their families.
This is an opportunity for health personnel to explore what
has led to this question.
They should be reassured that nothing is being done to
prolong their dying, they will not be abandoned to pain and
suffering and everything will be done to manage their
symptoms.
If they request sedation at the end of life, this can also be
given to them.
Nursing care at the end of life
Impeccable attention to symptom management.
Attention to skin integrity.
Maintenance of cleanliness and hygiene.
Incontinence management, including catheterisation for
patient comfort (a full bladder can be uncomfortable and
painful).
Management of terminal restlessness
Temperature control: fan, sponge down, Paracetamol
suppository
Mouth care
Nursing care at the end of life2
Communication with family. Massage therapy Pet therapy. Music therapy. “Comfort Care Clinical Pathway” No unnecessary interventions!!!! (EMPHASISE THIS)
