Care of the Patient at End of Life
Care of the Patient at End of Life
Recognize the dying phase: progressive weakness, reduced intake, increased sleep, withdrawal from conversation, cool or mottled extremities, irregular breathing, and changes in urine output. Not every sign appears, and some patients remain interactive. Focus on comfort, dignity, and family support. Continue symptom medications by an appropriate route; discontinue nonbeneficial tests, medications, and treatments. Address pain, dyspnea, agitation, secretions, fever, and dry mouth. Terminal agitation may be delirium, pain, urinary retention, or existential distress, so assess before sedating. Terminal secretions are often not distressing; reposition and use anticholinergics rather than deep suction. Artificial hydration may worsen edema, secretions, and dyspnea; discuss goals rather than defaulting. Provide post-death care according to policy and culture, support family, and address donation and pronouncement.
Traps: withdrawing comfort medications along with curative ones; routine suctioning; forcing fluids; treating terminal agitation only with sedatives; and assuming all patients lose consciousness. Do not overlook family education about what death may look like.
Worked example/rule of thumb: a dying patient with fever and likely aspiration pneumonia, when the goal is comfort, should have dyspnea and fever treated and a discussion about whether antibiotics align with goals; do not simply order them because it is pneumonia. Rule: comfort, goals, and family preparation guide every intervention in the last days.