The five priorities focus on: recognising that someone is dying; communicating sensitively with them and their family; involving them in decisions; supporting them and their family; and creating an individual plan of care that includes adequate nutrition and hydration.
Decisions about care at the end of a person's life often involve quality-of-life considerations. Nurses are obligated to provide care that includes the promotion of comfort, relief of pain and other symptoms, and support for patients, families, and others close to the patient.
Terminally ill cancer patients near the end of life can experience refractory symptoms, which require palliative sedation. Midazolam is the most common benzodiazepine used for palliative sedation therapy.
The focus of hospice care is to provide pain management and medical care, emotional support, and spiritual counseling for the dying patient, and similar emotional and spiritual help and support for family members.
Denmark. When a loved one nears the end of his or her life in Denmark, a special tradition unfolds. It's a simple act – a swift gesture that takes little effort, but says so very much: the opening of a window for “the soul” of the loved one to pass through once they have died.
The end-of-life period—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks. Some patients die gently and tranquilly, while others seem to fight the inevitable. Reassuring your loved one it is okay to die can help both of you through this process.
A bystander hands a medicine bottle to the attending paramedic frantically saying, “They drank this! They drank this!” The bottle contains digoxin 100 mg, diazepam 1,000 mg, morphine 15,000 mg, amitriptyline 8,000 mg and phenobarbital 5,000 mg.
Identification of acute pain and ineffective breathing are areas that typically become priority as patients near their final transition. Additionally, attention to family coping and caregiver role strain remain areas of focus as the nurse assists family members in coping with the dying process.
Your loved one may sleep more and might be more difficult to awaken. Hearing and vision may decrease. There may be a gradual decrease in the need for food and drink. Your loved one will say he or she doesn't have an appetite or isn't hungry.
The following are the nursing priorities for patients in hospice care: Provide symptom management and comfort measures. Facilitate open and honest communication. Support decision-making and advance care planning.
Offer to wash their face with a wet washcloth and make sure their clothes remain clean. Be sure to keep the temperature of the room comfortable to their standards despite how others in the room may feel. Those are just simple ways to ensure their dignity and comfort in that time in their lives.
Your loved one should be turned and repositioned at least once every 2 hours. Try not to disturb your own sleep. The better way to manage nighttime turning is when you awaken to give medications or to use the bathroom.
In time, the heart stops and they stop breathing. Within a few minutes, their brain stops functioning entirely and their skin starts to cool. At this point, they have died.
As the end of life nears, the body gradually loses its ability to digest and process foods and liquids. As organs and bodily functions shut down, minimal amounts of nutrition or hydration/liquids might be needed, if at all.
About palliative medication
Providing palliative medication (e.g. morphine, fentanyl, hydromorphone, midazolam and haloperidol) is a key part of good palliative care. It helps relieve and manage the pain and symptoms of a person with a life-limiting illness.
Medicine for pain in palliative care – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil. Medicine for breathlessness – midazolam or an opioid. Medicine for anxiety – midazolam. Medicine for delirium or agitation – haloperidol, levomepromazine, midazolam or phenobarbital.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage. Though the active stage can be different for everyone, common symptoms include unresponsiveness and a significant drop in blood pressure.
The active dying process lasts days to weeks and takes a toll on both the patient and their family and friends. With the help of All American Hospice, patients will be given the proper care, and their loved ones will have the support they need.