Exam #2: Managing Non-Pain Symptoms at End-Of-Life Flashcards
How can you help a patient that wants to die at home?
Regularly review the plan of care
What are the signs and symptoms of imminent death (1-3 months)?
- Withdrawal from world
- Turning inward
- Less communication
- Increased reflection
- Decreased nutritional intake
What are the signs and symptoms of imminent death (1-2 weeks)?
- AMS
- Dreams/ visions
- Agitation
- Maybe not eating or drinking & then request a full meal
- Unfocused/ dreamy eyes
What do you need to remember about a person that requests a full meal?
This may be misinterpreted by the family–remind them it is a sign of dying
What are the signs and symptoms of imminent death (days to hours)?
- Surge in energy (also misinterpreted by the family)
- Breathing grows shallow
- Apnea
- Gurgling–called the death rattle
- Skin grows dusky/ blotchy
- Eyes remain open but don’t blink
What are the physiological changes that occur during the dying process?
Weakness/ fatigue Decreased appetite Decreased perfusion Neurological dysfunction Pain Loss of ability to close eyes
What is the mnemonic to remember the changes that happen during the end of life?
ICHABOD Sydrome
I= immobility C= confusion H= homeostatic failure A= anorexia B= breathing changes O= oral intake decreased D= dyspnea
What is important to remember about weakness and fatigue seen in the dying?
Increase risk for bedsores
Stiffness
What is helpful for family members to know about food intake in the dying?
- Food intake may be nauseating
- The drive for hunger diminishes
**This is due to low blood flow to the GI tract
Where does thirst, taste, and hunger come from
Thirst= mouth Taste= mouth Hunger= stomach
What negative impact can artificial hydration have on a patient?
Body is shutting down and can’t handle the fluid
- Edema
What is the take home message about IV fluids and decreased blood perfusion?
IV fluids will NOT help this; it will go into alternative spaces
Can unconsciousness patients still be aware of their environment?
Yes, they can likely still hear–need to inform family’s of this
What do you need to tell families about sphincter control?
Sphincter control is lost during the dying process–families need to be aware of this so it doesn’t freak them out
What road of death do medical professionals need to engage in?
The difficult road with/ tremors, hallucinations, humbling, jerking, seizures
What is a good test for decreased consciousness in the dying?
Eyelash reflexes
What types of questions should you ask patients decreased level of conscousness?
Simple yes vs.no
What is the decision for supplemental oxygen based on?
- Comfort of the patient
- Family concerns
**Need to inform them that it may PROLONG death
Why don’t you suction dying patients?
They reflexively bite down and break teeth…etc.
What should you do when a patient has decreased renal clearance?
STOP opiate infusions & use PRN
**Also, note that dermal analgesics likely aren’t going to work well
What route is inappropriate for patients that are dying?
IM
