Terminal Secretions Flashcards
Where do you administer Atropine 1% Eye Drops?
1) Inside lower eyelids
2) Sublingually
what are the other drugs you can use?
1-2 drops q4h-q6h given sublingually
Pharmacological Approach for Terminal Secretions
No one anti-secretory medication is better than another.
Start anti-secretory medication early as it does not remove secretions which have already accumulated in the airways
Options
1) Hyoscine Butylbromide SC/IV (20mg stat dose for SC)
2) Hyoscine Hydrobromide SC/IV (SC 200mcg)
3) Atropine Sulphate (1%) eyedrops –> S/L
4) Glycopyrrolate (Glycopyrronium) –> S/L
What are the nursing management for Terminal Secretions?
-> Family Care, -> Pharmaco, -> Non-pharmaco
Family Care
- Explain why patients have secretions and that it is part of the normal dying process.
Explain secretions are generally considered not distressing to patients.
Explain the use of anti-secretory medications to reduce secretions.
Explain suctioning may cause more distress if family request for it.
What is another term for Respiratory secretions?
Respiratory secretions (rattling) are often observed in an imminently dying person.
The cause is suspected to be due to salivary secretions or bronchial secretions accumulating in the pharynx and upper airways as patient becomes increasingly unconscious.
It often indicates a short prognosis.
In general it is within hours to short days after secretions are first diagnosed.
List some of the non-pharmacological approach to terminal secretions/ death rattling
- Position patient on side or semi-prone position, head down, to allow some oral secretions to flow out of mouth.
Place a towel below the mouth to absorb the secretions. - Ensure good mouth care
- Stop or reduce parenteral fluids (<500mls/day)
- Most secretions are below the larynx and inaccessible to suctioning. Routine suctioning is uncomfortable and usually not necessary if measures mentioned here are in place.
