As an experienced hospice nurse, I have seen many patients at the end of their lives. It is crucial to understand that the dying process is a natural part of life, and it is our responsibility to make it as comfortable and dignified as possible. Below are some common end-of-life symptoms that you may encounter and some tips on how to manage them effectively.
Pain
Pain is one of the most common symptoms experienced by people at the end of their lives. It is essential to address pain immediately and consistently throughout the hospice journey. Some tips to manage pain include:
Identify the source and nature of the pain
Use the right pain medication based on the pain’s intensity and type
Administer medications regularly and as prescribed
Adjust the medication dosage based on the patient’s response
Use complementary therapies such as music therapy, massage, and relaxation techniques to supplement pain medications.
Some commonly used pain medications include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
Acetaminophen (Tylenol)
Opioids such as morphine or fentanyl.
Shortness of Breath and Respiratory Distress
Shortness of breath and respiratory distress can be challenging for the patient and their family. The following tips can help manage these symptoms:
Sit the patient upright to make breathing easier
Use a small fan on the lowest setting pointing towards the patient’s right or left cheek
Consider morphine or other opioids to reduce respiratory distress.
Consider Lorazepam if the patient is hyperventilating as part of the shortness of breath or the shortness of breath is anxiety driven
Anxiety
Anxiety is a common symptom experienced by people at the end of their lives. It can stem from many sources, including fear of dying, pain, or changes in their physical and mental state. To help manage anxiety, try the following:
Identify the source of anxiety and address it directly
Use relaxation techniques such as deep breathing or meditation
Administer anti-anxiety medications such as lorazepam or diazepam
Encourage the patient to express their fears and concerns and provide emotional support.
Terminal Restlessness and Terminal Agitation
Terminal restlessness and terminal agitation are common in the final days or hours of a patient’s life. The following tips can help manage these symptoms:
Identify the underlying cause, such as pain or anxiety, and address it appropriately
Use medications such as haloperidol or lorazepam to manage restlessness and agitation
Provide a calm and peaceful environment
Offer emotional and spiritual support to the patient and their family.
Non-Pharmacological Treatments
Non-pharmacological treatments can be used alone or in conjunction with medications to manage end-of-life symptoms. Some non-pharmacological treatments that can help include:
Managing end-of-life symptoms requires a holistic approach that considers both the patient’s physical and emotional needs. As a hospice nurse, it is crucial to identify and address symptoms promptly, provide comfort and dignity to the patient, and support their family throughout the hospice journey. Remember, hospice care is about making the patient’s final days as comfortable and peaceful as possible.
