Transcript End of Life Care: Helping Patients rest easy

End-of-Life Care: Helping
Patients Rest Easy
By MaryLou Kouch, APRN, BC, MSN
LPN2007, July/August 2007
2.0 ANCC/AACN contact hours
Online: www.nursingcenter.com
© 2007 by Lippincott Williams & Wilkins. All world rights reserved.
End-of-Life Concerns

pain

fatigue

ascites

gastrointestinal problems
Assessing Pain
Ask the following questions when assessing pain:

Can you point to the pain or is it everywhere?

Does it travel? If so, where?

How do you rate your pain on a scale of 9 (no pain) to 10
(worst pain)?
Assessing Pain

How would you describe your pain (dull, aching, lancing,
burning, sharp, itching, throbbing, squeezing, tingling)?

Is pain always present, or does it come and go?

Does it come on quickly or build slowly?

What relieves your pain? What aggravates it?
Assessing Pain

What adverse reactions have you had?

What treatment, including medications and
complimentary therapies, have you had? How did each
one work?

What do you think is the reason for the pain?

How is this pain affecting your life, emotions,
relationships?
Relieving Pain

Do a complete assessment.

Adjust doses as needed.
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Provide medication for “breakthrough” pain.

Teach patient and caregivers potential adverse effects of
pain medicine (e.g., constipation).
Fatigue

concern for patients being able to perform activities of
daily living

can be caused by pathophysiologic factors due to
disease process, treatments, environmental stressors
Treating Fatigue

Consult with interdisciplinary team.

Attempt to discover the cause if possible.

Tailor treatment accordingly (e.g., if patient not sleeping,
offer medication for sleep as prescribed).
Ascites

Accumulation of fluid; can be due to tumor processes.

Therapeutic paracentesis can be done (for relief of
symptoms to make patient more comfortable; not a
curative measure).
Gastrointestinal Problems

nausea

feeling of fullness

constipation
Dealing with GI Problems

Offer smaller more frequent meals if tolerated; high
protein can aid in lessening nausea.

Patient can take medication for nausea and constipation;
(e.g., Compazine, Reglan) can be offered in other forms
besides P.O.

Offer fluids in small amounts more frequently, also as
tolerated.

As death is imminent patient may be NPO; suck on
lollipops, water ice, ice chips.
Dealing with a Bowel
Obstruction

Possible causes: tumor mass, effects of treatment,
medication.

Complete or partial obstructions can occur anywhere in
intestines.

Surgery may be appropriate if tolerated.

Nasogastric suction may be used but can be
uncomfortable and make breathing and talking difficult.
Dealing with Patient Anxiety

Patients may be depressed or anxious.

Perform a psychosocial assessment.

Consult with interdisciplinary team.

Patient may benefit from chaplain or other spiritual
counselor.
Is Your Patient Depressed?

Typical symptoms: severe fatigue; inability to
concentrate or make decisions; feelings of sadness,
worthlessness, extreme guilt.

Health care provider may prescribe SSRIs, but may take
4 to 6 weeks to work.

For patient with no time to spare, methylphenidate
(Ritalin) may be good alternative; improvements seen in
day or two.
Constant Adjustments

Goal is to keep patient as comfortable as possible.

Continued reassessment of patient’s condition needed.

Collaboration with patient, caregivers, team can aid in
meeting this common goal.
Nearing the End
Prepare patient and family for signs and symptoms of
impending death:
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wet, slow, shallow breathing

urinary changes (incontinence, little output)

increased pain, moaning, restlessness

cool extremities, may be discolored
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brief pauses in breathing