Understand common symptoms and how to provide comfort as these symptoms occur.
Be there for them; often just being present is enough. It may not be necessary to talk or fill the time with activity. Your quiet presence can be a simple and profound gift to a dying family member or friend. If the patient is not agitated or trying to sleep, physical contact like holding their hand or a soft gentle massage may be comforting and make them feel more connected to their loved ones.
Delirium is a sudden change in a person’s mental status over a period of hours to days. It is a mental clouding with less awareness of one’s environment. They may be confused about time, place and person. They may have their days and nights mixed up. Delirium is common at the end of life. It has many causes. The team will try to determine what is causing the delirium and treat the symptoms.
Nausea and Vomiting
Nausea and vomiting may be related to the disease process, constipation, or the medications being taken. If the patient has nausea and/or vomiting let the nurse know. Together, you will determine the cause and treat it accordingly. Medications can be ordered if nausea and vomiting is an ongoing problem.
Terminal Secretions or “Death Rattle”
In the last hours of life, you may notice a rattling or wet sound in the patient’s breathing. This happens because fluids build up in the back of the throat and in the upper airways. We have all experienced this accumulation of fluid, but as healthy individuals, we are able to swallow or spit out any excess secretions.
Shortness of breath (SOB) is a common symptom at the end of life. It can occur with disorders of the lungs such as cancer or COPD. It can also be a result of fluid retention. If the patient feels he/she cannot get enough air, it can be very distressing. If the patient has had difficulty breathing in the past, or has a disease prone to cause shortness of breath, the nurse will order the necessary equipment (oxygen) and medications to be kept in the home.
Confusion, Restlessness and Agitation
As a person declines, they may become confused, restless, or have increased agitation. Even though they are too weak, they may insist on getting out of the bed. They may yell out and become angry toward those around them. They may say or see things that have no meaning. Some may accuse those trying to help of causing them harm. They appear extremely agitated and are sometimes unaware of their current condition. Caregivers should remember this is not who they are – this is from the disease and how it is causing changes to the body.
Constipation is one of the most common problems patients experience at the end of life. Whether we eat or not, our body still produces waste and that waste needs to be eliminated. As the disease progresses, our body movements slow down. Inactivity can contribute to constipation. Pain medicine also slows our bodily functions. Anyone who is taking pain meds needs to be on a regular bowel program including stool softeners and/or laxatives.
You are a part of your healthcare team. You should talk about your pain and discuss questions and concerns with us before it becomes a problem. We will work with you to manage your pain. The longer pain goes untreated, the harder it is to relieve.