Last Days of Life

Question 1

What are the signs ans symptoms that indicate the prognosis of the patient is short?

Answer 1

• Profound weakness
• Confined to bed for most of the day
• Drowsy for extended periods
• Disorientated
• Severely limited attention span
• Losing interest in food and drink
• Too weak to swallow medication

Question 2

What should be communicated and agreed with the family and patient who is dying?

Answer 2

• Check patient’s understanding of what is happeneing
• Explore fears and concenrs
• Understanding of family checked and their wishes considered
• Spiritual and religious needs
• Place of care and death should be negotiated
• Involve family/carers in practical care as much as they wish

Question 3

What nursing needs of the patients should be considered towards the end of life?

Answer 3

• Treat dry mouth with good regular mouth care
• assess immobility and pressure areas -special beds may be needed
• Consider catheter, convene or pads for incontinence
• Consider bowel care if constipation causing discomfort of agitation

Question 4

In the last days of life what is a patients attitude to food and fluids? What should be done with regards to food and fluid?

Answer 4

• reduced need for food and fluids part of the normal dying process
• paients should be supported to take food and fluids by mouth for as long as tolerated
• clinically assisted hydration does not usually contribute to dying patient’s comfort and may worsen symptoms (pulmonary oedema)

Question 5

What are the benefits of withdrawing artifical hydration/nutrition in a patients last days of life?

Answer 5

• Less vomiting and incontinence
• Reduction in barriers between patient and family/carers
• Preventon of painful venepuncture

*remember patients are dying from their disease not from lack of food or fluis. dry mouth =relieve via good mouth care

Question 6

What medication is continued in the last days of life? What can be stopped and why?

Answer 6

• Only continue medication needed for symptom management
• if oral route not appropriate use the rectalm transdermal or subcutaneous route
• following can be stopped when patient no longer able to swallow
  
  • vitamins/iron
  • hormones
  • anticoagulants
  • corticosteroids
  • antibiotics
  • antidepressants
  • cardiovascular drugs
  • anticonvulsants used for pain

Question 7

Whata re the causes of terminal restlessness? Management?

Answer 7

Reversible causes:

• pain
• urinary retention
• faecal impaction
• respiratory secretion

=treat by treating cause

• if no cause found then sedation often required =midazolam useful short acting sedative

Question 8

What is the death rattle? How do you manage it?

Answer 8

• It is the rattling noise produced by the movement of secretions in the upper airways generally in patients who are too weak to expectorate effectively
• Usually no distressing to patient but can be for family

Management

• Repositioning of aptient may help
• Antisecretory drugs can be prescribed
  
  • hyoscine butylbromide or hyoscine hydrobromide

Question 9

What is a DNACPR?

Answer 9

• Legally binding contract signed by patient saying that in the event of death, not medical intervention i.e. CPR will be given
• Should be agreed with the patient in palliative care