It is not necessary to do further observations, bloods, tests & investigations. Constantly assess comfort in a holistic manner.
Be alert for:
Discomfort & pain (failure to address psychological distress & social / cultural issues is a common cause of unrelieved pain)
Restlessness / agitation
Respiratory distress
Retained secretions
Nausea / vomiting
Confusion / hallucinations / delirium
Also check for:
Pressure areas / skin integrity
Faecal impaction / overflow. A PR may be necessary if suspected
Urinary retention
Rationalise all current medications & stop those not required for comfort (including IV fluids)
Consider route of administration – usually subcutaneous at this stage
Chart anticipatory medications all subcutaneously (refer to the palliative care website)
Opioid – pain, discomfort, shortness of breath
Buscopan – secretions (death rattle)
Haloperidol – nausea, confusion, agitation, delirium
Midazolam – agitation, distress, anxiety, shortness of breath
Opioids: morphine is the gold standard (renal function dependent).
Regular mouth cares (to alleviate dry mouth and thirst)
Bowel / urinary cares
Skin cares
Body positioned and covered appropriately for comfort (hot / cold)
Surroundings safe and tidy
Encourage family involvement, e.g. holding hands, washing, mouth cares, touch & gentle massage
Encourage conversations with family in an open & honest manner to elicit any fears and concerns
Avoid withholding difficult information
Encourage a relaxing environment, e.g music at low volume & soft lighting
Keep distracting noises like televisions & radios to a minimum
Encourage loved ones to reminisce
Respect the family’s need for privacy
Honour their wishes. Is there a current & valid Advance Care Plan? Have there been informal advance care planning discussions?
Offer Chaplain and family support services
IKA SYAMSUL HUDA MZ