Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Core Section II: Frequent Symptoms Associated with Imminent
Transcript
Section II: Frequent Symptoms Associated with Imminent Death Core Two Roads to Death Confused Restless Tremulous THE DIFFICULT ROAD Hallucinations Mumbling Delirium NORMAL Myoclonic Jerks Sleepy Lethargic Seizures Obtunded THE USUAL ROAD Semicomatose Comatose DEAD NCI, 2014; Seow et al, 2011 Core Most Common Symptoms in Final Days of Life Kehl & Kowalski, 2013 Core Physical Symptoms Vary Confusion, disorientation, delirium vs. unconsciousness Drowsiness, sleeping vs. restlessness/agitation Weakness and fatigue vs. surge of energy Physical considerations: Fever Bowel changes Incontinence Decreased intake Core Pain During the Final Hours of Life Changes in level of consciousness may make assessment and management of pain challenging. If self-report is not possible, behavioral cues, proxy report, analgesic trials What is causing the pain? Core Opioids Dosing of opioids given during last hours based on appropriate assessment and reassessment. Dose may be decreased or increased Consider other routes: Oral Rectal Subcutaneous Core What About the Principle of Double-Effect? Is it morally permissible? Intent There will always be a last dose. Core National Comprehensive Cancer Network (NCCN): Guidelines for Treating Pain Weeks to Days Before Death Titrate to comfort Recognize and treat toxicities Analgesia vs. reduced LOC Use equianalgesic dose conversions Consult Consider sedation for refractory pain Core Myoclonus Assess potential etiologies Benzodiazepines can be helpful (i.e., diazepam) Switch opioids Can lead to seizures Core Terminal Secretions Respiratory congestion/terminal secretions Distressing and frightening to family, friends, healthcare providers Assessment Management Core Palliative Sedation at End of Life Consider: All possible etiologies and treatments Education of patient/family regarding goals and outcomes Interdisciplinary team approach Medications Core Symptoms of Imminent Death Decreased urine output Cold and mottled extremities Vital sign and breathing changes Delirium / confusion Restlessness Core Case Study: Gail (cont) Gail is now unconscious Pain assessment Reassurance to family Death rattle Concerns about dehydration Core The Death Vigil Family presence Common fears Being alone with patient Painful death Time of death Giving “last dose” Bedside Vigil Core Nursing Interventions: Support Collaboration with physician/team Reassurance and education Role model comforting Physical comforting Spiritual care; honor culture Core
