11 Assessing and Responding to Physical Changes and Symptoms at the End of Life Although each person’s death is as unique as the life lived, there are symptoms that hospice nurses assess and treat regularly. This chapter discusses common end-of-life symptoms along with palliative nursing interventions. Medications that are commonly used to treat these symptoms are also presented. After reading this chapter, you will be able to: ■ Identify common end-of-life symptoms ■ Discuss appropriate nursing interventions used to treat end-of-life symptoms ■ Name medications used to treat end-of-life symptoms COMMON END-OF-LIFE SYMPTOMS Anxiety Anxiety often occurs at the end of life as patients experience a lack of control over their own health and face their own deaths. Anxiety often manifests as agitation, inability to sleep, irritability, and inability to focus (see Exhibit 11.1). Exhibit 11.1 Interventions for Anxiety Nursing interventions ■ Offer therapeutic presence and therapeutic touch ■ Play soothing music ■ Teach deep breathing and relaxation exercises ■ Assure quality care until life’s end ■ Collaborate with members of the interdisciplinary team to help identify and treat the cause of the anxiety Pharmacologic treatment options ■ Antidepressant therapy (if depressive symptoms coexist) ■ Benzodiazepines (e.g., lorazepam, temazepam) ■ Barbiturates (e.g., pentobarbital, thioridazine) Source: Kinzbrunner, Wright, Schlecter, and Maluso-Bolton (2011). Edema Lower extremity edema can occur at the end of life due to chronic conditions such as heart failure or liver disease. Other causes such as immobility, metastasis, and blood clots can also lead to peripheral edema (Kinzbrunner & Wright, 2011). Edema can cause discomfort, weakness, and decreased mobility. Edema that arises at the end of life is often refractory (see Exhibit 11.2). Exhibit 11.2 Interventions for Edema Nursing interventions ■ Elevation of lower extremities ■ Excellent skin care ■ Limit salt intake Pharmacologic treatment options ■ Diuretics ■ Albumin (IV) Source: Kinzbrunner and Wright (2011). Constipation Constipation is a common symptom at the end of life that may be caused or exacerbated by medications (especially opioids), decreased fluid intake, and immobility. Neurological diseases and spinal cord injuries may also contribute to constipation. Bowel obstruction secondary to adhesions or tumors can also cause an inability to pass stool (Kinzbrunner & McInnis, 2011; see Exhibit 11.3). Exhibit 11.3 Interventions for Constipation Nursing interventions ■ Encourage fluid intake ■ Schedule toileting ■ Increase mobility as tolerated ■ Increase fiber intake as tolerated ■ Monitor for loose stools or diarrhea that may be a sign of a fecal impaction ■ Carefully document bowel regimen ■ Administer stool softeners routinely (not prn) for patients on opioid medications ■ Digitally disimpact if necessary (patient should be premedicated for pain/anxiety) Pharmacologic treatment options ■ Polyethylene glycol 3350 ■ Docusate sodium ■ Senna/docusate sodium ■ Bisacodyl (po or suppository PR) ■ Fleet enema ■ Lactulose Sources: Hellsten and Berg (2015); Kinzbrunner and McInnis (2011). Delirium Delirium typically has an acute onset and involves “impaired attention, altered awareness, and a variety of cognitive and neuropsychiatric disturbances” (Adamis, Devaney, Shanahan, McCarthy, & Meagher, 2015, p. 1). Delirium that occurs around the time of death is often called “terminal agitation” and may include fearfulness and hallucinations (Heidrich & English, 2015). Early intervention is necessary to reverse symptoms of delirium, if possible. In rare cases, palliative sedation may be considered as a last resort (Kinzbrunner, Wright, Schlecter, & Maluso-Bolton, 2011; see Exhibit 11.4).
Nurse Key
Fastest Nurse Insight Engine
