Tag: Terminal Restlessness

Articles about terminal restlessness and terminal agitation including management with the goal for comfort at end-of-life.

Managing Terminal Restlessness

Exhausted Patient From Restlessness
Losing a loved one is an incredibly challenging experience, and witnessing changes in their behavior and well-being can be distressing. As a hospice nurse, I've supported many families and caregivers through this grim time. One common symptom that may arise towards the end of life is restlessness. In this article, I will explain the different types of restlessness and offer guidance on how to manage them. Understanding these distinctions can provide valuable insights into your loved one's condition and help you navigate the final stages of their life with compassion and care.
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Trigger Words for Hospice Nurses: Assessing End-of-Life in Two Weeks or Less

Signs of imminent death
Hospice visits by a nurse should always include a discussion with the caregiver and family members or facility staff about any changes since the last nursing visit. This interviewing process is extremely important because vital signs do not always provide clear indications when a patient is two weeks or less away from death. If we hear or read certain words or phrases in the notes, we should be on high alert for the possibility that the patient is either transitioning towards actively dying or is otherwise close to transitioning.
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The Actively Dying Phase of The Dying Process

Signs Indicating Death Is Imminent
A non-healthcare professional who has never witnessed death before, it can be unsettling to be present with someone who is nearing the end of their life. However, there are certain signs and observations that you can make using your own senses that may indicate that the person you are with may pass away within seconds, minutes, or hours. Understanding these signs can help you provide support and comfort to both the individual and their loved ones during this grim time.
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Breathing Patterns Before End of Life: Critical Clues for the Last Hours!

Breathing Patterns
This article is intended for family members, caregivers, as well as nurses new and old. As an experienced hospice nurse, I've learned that when a family member or caregiver tells me their loved one is or has "goldfish breathing" or "fish out of water breathing" or "taking guppy breaths" that the patient is now at the end of their life.
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Clues for terminal restlessness often missed for facility patients

Exhausted Patient From Restlessness
One of the hardest portions of the job of a hospice nurse is to identify when a patient has two weeks of life left to live; this can be especially difficult at facilities going through staffing shortages leading to inconsistent caregivers with little to verbally report on a patient’s change of condition. Since being aware of the velocity of declines is extremely important, let’s cover an area that we in hospice (nurses, families, and caregivers alike) can keep an eye on in terms of identifying terminal restlessness which is often a key indicator for one week or less of life.
Read MoreClues for terminal restlessness often missed for facility patients

Delirium vs Terminal Restlessness

delerium vs terminal restlessness
As an experienced hospice nurse, I understand how difficult it can be to distinguish between delirium and terminal restlessness. Both conditions can cause significant distress for the patient and their loved ones, and it’s crucial for nurses to be able to tell the difference between the two to provide the best possible care. In this article, I will share my knowledge and experience to help new hospice nurses understand the differences between delirium and terminal restlessness along with ways to rule out delirium.
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Terminal Restlessness in the Completely Nonverbal Patient

Terminal restlessness is a common phenomenon that occurs in the final stages of life, characterized by agitation, confusion, and distress. It can be challenging to recognize and manage, especially in patients who are unable to communicate verbally. This article aims to share some insights and tips from a hospice worker who learned how terminal restlessness can manifest differently in nonverbal patients, and how to cope with it.
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End-of-Life Determinations for Newly Admitted Patients

how people die trajectory
Admitting a patient to hospice services is a difficult and sensitive process that requires careful assessment and communication. One of the challenges that hospice nurses face is to determine if the patient is close to the transitioning phase of dying, which is the final stage of life when death is imminent. This phase usually lasts for one to two weeks, and it is important to prepare the family and provide a plan for increased hospice involvement during this time. However, on admission, hospice nurses do not have the luxury of having visited with the patient over the past several weeks to months to observe the changes that often signal that death is approaching. Therefore, they need to rely on other indicators that can help them identify if the patient is in the transitioning phase or not.
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Validation Therapy: A Valuable Tool for Families and Healthcare Teams

Naomi Feil is an expert in gerontology and the creator of validation therapy which is a means of communicating and acknowledging the internal reality of patients with dementia. When properly utilized, validation therapy can enhance the quality of life of patients with dementia as well as reduce stress of the family and caregivers. While Naomi Feil and her followers (of which the writer of this article may be considered one at least in form) focus on the use of this method of communication for maintenance of health with the potential for a level of restorative health, I want to share how the concepts of this method can be used during times of crisis.
Read MoreValidation Therapy: A Valuable Tool for Families and Healthcare Teams

Interviewing and Observation as part of the assessment

There are observation and interviewing skills you can develop which will help you learn: What could cause the current change of condition Determining if a patient is having terminal restlessness Determining if your patient is within two weeks or less of life to live Knowing where your patient is in the dying process While this article is primarily meant for new nurses, what I’m sharing is also valuable for family members and loved ones as these skills can be honed and developed by anyone with patience and love towards the person being observed and interviewed.
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The dying process at the end of life

Body And Soul
Living is a continuum where we start life (scientifically) from conception as a pre-born human being and are actively living from that time then through the birthing process and as we grow from child to adolescent to adult. We are actively living without regard to the quality of life we are living at the time. As we arrive closer to death, we often go through a transitioning phase prior to actively dying. In this article I would like to go over the dying process at the end of life covering frequent questions such as “what is transitioning?” and “how do I know if my loved one is actively dying?” or “what are the phases of dying?” The phases of dying can be broken down into two phases: transitioning towards actively dying and actively dying.
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Recognizing the Approaching End of Life

When I first started working in the field of hospice, my clinical manager told me (I’m paraphrasing), one day you will be able to walk into the room, and without getting a single vital sign, just by visual observation, be able to tell that the person is dying or will be shortly dying. That was about three years ago. Today, it’s almost chilling for me (as it is both a blessing and tremendous responsibility) to be able to share she told the truth, and that over time — if you give yourself patience and grace and take the time to listen, observe, and remember — you too will learn how to tell when someone is close to or otherwise is dying. Please allow me to share some of my insight as to how I know a person has less than a month left to live, and often far less. First off, let’s go into the important discussion you should have with the family, friends, and the patient themselves that provides an overall background to the prognosis. That discussion should be centered around what types of decline (downward, negative) changes have been taking place in the patient’s life over the last six months making note as to whether the decline is minor, medium, or major and the frequency (once a month, once a week, etc.) of those changes.
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Understanding Terminal Restlessness

Navigating the final days of a loved one's life can be a challenging and emotional journey. One of the signs that can be observed during this time is known as terminal restlessness. As someone deeply rooted in the realm of hospice care, I have witnessed various manifestations of this restlessness. Understanding its types, causes, and management strategies is crucial for providing compassionate end-of-life care. This article aims to shed light on the different types of terminal restlessness, identify reversible causes, and discuss effective management techniques. By equipping caregivers, families, and healthcare professionals with this knowledge, we can ensure that the terminally ill individual experiences comfort and dignity in their final days.
Read MoreUnderstanding Terminal Restlessness

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