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Common Symptoms at End of Life

Common Symptoms at End of Life. Stephanie Reynolds, MSN, NP, ACHPN Palliative Care, Jacobi Medical Center. Assess. Patient looks uncomfortable: Pain? Anxiety? Dyspnea? Make sure that you rule out: Discomfort because of hygiene needs, need for repositioning

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Common Symptoms at End of Life

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  1. Common Symptoms at End of Life Stephanie Reynolds, MSN, NP, ACHPN Palliative Care, Jacobi Medical Center

  2. Assess • Patient looks uncomfortable: • Pain? • Anxiety? • Dyspnea? • Make sure that you rule out: • Discomfort because of hygiene needs, need for repositioning • Constipation, urinary retention • Thirst, dry mouth

  3. Preventing Pain • If the patient has a reason to have pain, they are likely in pain. • Avoid repeated subcut injections if possible – can be painful • IV medication is best if pt is unable to swallow • May need to consider continuous drip to provide steady level of pain medication in bloodstream

  4. Preventing Anxiety • Why is this patient agitated? • May be pain, dyspnea, constipation, hunger… • Avoid restraints • Order standing or prn medication for anxiety • Avoid Ativan IM, if possible; give either IV or SL • Chaplain?

  5. Preventing Dyspnea • Opioids very effective for dyspnea, but given at much lower doses than for pain • i.e. morphine liquid 2-5 mg PO or via GT/NGT q 6 hrs standing • Anxiolytics are also helpful • Consider a fan at bedside (we have some!)

  6. Other Symptoms • “Death rattle” / excess secretions • Levsin 0.125 mg SL q 6 hrs around the clock • Glycopyrrolate 0.1-0.2 mg IV q 8 hrs around the clock • Diminished blinking • Natural tears eye drops, 2 drops to both eyes q 6 hrs and prn • Dry mouth • Artificial saliva, 5 mL q 6 hrs – apply to oral swab for mouth care • Ice chips

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