Common symptoms at end of life may include pain, constipation, nausea, breathlessness, fatigue and delirium. Relieving these symptoms is a key aim of palliative care.
Pain is one of the most common symptoms experienced by dying persons at the end of life due to disease progression or worsening of chronic conditions.
The incidence was noted of pain, dyspnea, moist breathing, nausea and vomiting, confusion, restlessness, jerking and twitching, difficulty in swallowing, incontinence and retention of urine, sweating, moaning and groaning, and loss of consciousness.
Does everyone get pain when they are dying? No – not everyone gets pain in their last weeks, days or hours of life. Some people have no pain at all. However, we know that many people with a terminal illness do experience pain.
This can involve controlling pain and other symptoms, for example nausea, vomiting, constipation and breathlessness, as well as providing emotional and practical support.
The five priorities focus on: recognising that someone is dying; communicating sensitively with them and their family; involving them in decisions; supporting them and their family; and creating an individual plan of care that includes adequate nutrition and hydration.
Fatigue is the most common symptom at the end of life, but little is known about its pathophysiology and specific treatment.
Patients in the advanced stage of a serious and/or life-threatening illness typically experience multiple symptoms, the most common of which are pain, depression, anxiety, confusion, fatigue, breathlessness, insomnia, nausea, constipation, diarrhea, and anorexia (table 1) [3-7].
At the end of life, the body's chemical balance completely changes. The dying person then slips into unconsciousness. This is usually right towards the end, maybe only a few hours or days before death. The person's breathing becomes irregular and may become noisy.
People are considered to be approaching the end of life when they are likely to die within the next 12 months, although this is not always possible to predict. This includes people whose death is imminent, as well as people who: have an advanced incurable illness, such as cancer, dementia or motor neurone disease.
Stage 5 of palliative care focuses on providing bereavement support to the grieving family, friends, and carers, ensuring they receive emotional, spiritual, and psychological support through this difficult time.
The person's skin may feel cold and change colour. The person's hands, feet, ears and nose may feel cold to the touch (this is due to reduced circulation). Occasionally, a person's hands or other parts of the body may swell a little. Their skin may also become mottled and blue or patchy and uneven in colour.
The four main goals of end-of-life care: physical comfort, emotional and mental support, spiritual care, and practical assistance are all essential components of providing holistic and compassionate caregiving to individuals and their families during the final stages of life.
This includes pain, dyspnoea, delirium, agitation, respiratory secretions, and functional decline. Communication may be difficult. Assessment and monitoring can be based on signs such as agitation, restlessness, facial expression, body posture and changes in breathing.
Some of these signs include: A prolonged state of excessive fatigue, sleep, perhaps being comatose-like. Confusion and/or disorientation; Hearing or seeing people and events not visible and not present to you. Social withdrawal and detachment.
The following are the nursing priorities for patients in hospice care: Provide symptom management and comfort measures. Facilitate open and honest communication. Support decision-making and advance care planning.
Periods of rapid breathing, and no breathing for brief periods of time, coughing or noisy breaths, or increasingly shallow respirations, especially in final hours or days of life.
Patients experience serious psychological confusions – delusions, hallucinations, and delirium. The patient has a build-up of fluid in the lungs and is usually observed with gurgling sounds while breathing. The patient's eyelids can't be closed.
Palliative care is used to manage a disease or medical condition that is serious or life threatening by easing pain and other associated physical, emotional, or psychosocial symptoms. Palliative care also eases other distressing symptoms, like depression, anxiety, fatigue, insomnia, and shortness of breath.