Secretions Flashcards
Palliative care - secretions:
How do I know my patient has it?
Pooling of secretions such as saliva in the hypopharynx is likely if a gurgling, rattling, or bubbling noise can be heard persistently from the person’s airway during the terminal phase of life.
How should I assess a person with respiratory secretions in palliative care?
Consider why secretions have accumulated.
Assess for the likely causes of noisy respiratory secretions in people in the last days of life
In the terminal phase, explore the understanding and needs of the person (if appropriate) and their family.
People are likely to be in the terminal phase of their illness when they:
Deteriorate day by day or faster because of their underlying condition.
Express a realization that they are dying.
Have reduced cognition, and are drowsy or comatose.
Are bed-bound.
Take little food or fluid, and have difficulty taking oral medication.
Are peripherally cyanosed and cold.
Have an altered breathing pattern.
What conservative measures may ease symptoms in people with problematic respiratory secretions?
Reposition the person on one side with the upper body elevated. Appropriate body positioning encourages postural drainage.
When should I consider the use of drug treatment for respiratory secretions at the end of life?
Consider drug treatment in addition to conservative management if:
Positioning (and suction if available) fails to produce adequate benefit.
Symptoms are causing distress to the person or family.
In deciding whether or not to treat with drugs, the risks and benefits should be considered in addition to relatives’ distress, which may not have been alleviated by an adequate explanation that the semiconscious/unconscious person will not be distressed by the rattle.
How should I treat loose secretions?
Consider the risks and benefits of the use of medications and tailor treatment to the dying person’s individual needs or circumstances, using one of the following (off label indication) drugs:
Glycopyrronium bromide, or
Hyoscine butylbromide, or
Hyoscine hydrobromide, although this may cause sedation and confusion.
Monitor for improvements, preferably every 4 hours, but at least every 12 hours.
Monitor regularly for side effects, particularly delirium, agitation, or excessive sedation when using hyoscine hydrobromide.
Treat side effects, such as dry mouth, delirium, or sedation.
How should I treat secretions caused by a chest infection?
Whether to treat with an antibiotic often causes concern and depends on the individual person’s circumstances.
If infected secretions due to a chest infection are causing distress and are not easily managed by other means, occasionally it is appropriate to prescribe an antibiotic in an imminently dying patient if the death rattle is caused by profuse, purulent sputum associated with an underlying chest infection.
