Comfort Cares

Comfort Cares

“At the end of life each story is different”


Physical Comfort

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


Medications

  • 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)

  1. Opioid – pain, discomfort, shortness of breath

  2. Buscopan – secretions (death rattle)

  3. Haloperidol – nausea, confusion, agitation, delirium

  4. Midazolam – agitation, distress, anxiety, shortness of breath

Opioids: morphine is the gold standard (renal function dependent).


Physical Cares

  • 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


Psychological & Spiritual Needs

  • 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


Resources available:

IKA SYAMSUL HUDA MZ