Last Days Of Life Flashcards
(13 cards)
Signs of imminent death
Cheyne stokes breathing
Changes in skin colour
Cool extremities
Noisy breathing
Not E&D
Little/no swallow reflex
Agitaiton/restlessness
Change in continence
Define spirituality
The way in which we know ourselves, yhe thoughts and feelings we have about who we are and what our purpose is.
Most common symptoms in last 48 hours of life
Pain
Breathlessness
Noisy secretions
Restlessness/agitation
Nausea/vomiting
Medication available for secretions
Glycopyrronium bromide (600micrograms - 2.4mg in 24 hrs via CSCI)
Hyoscine butylbromide (20-60mg/24hr via CSCI)
Non-medical management of secretions
Positioning
Reassuring relatives
Regular mouth care
Suction - rarely needed/effective. Can be traumtic
Reversible causes of agitation
Drug toxicity (renal/liver function declining therefore need tweak meds)
Withdrawal (not taking PO, patch coming off, nicotene/alcohol)
Hypoxia
Pain
Medication available for agitation
Midazolam - 5-60mg/24hr via CSCI
Levepromazine 25-100mg/24hr via CSCI
Medications available for breathlessness
saline nebs
Continuous O2
Low dose opioids (morphine 5-10mg/24hr via CSCI with 2mg as PRN
Benzodiazepine or midazolam (2.5-5mg SC hourly if needed
Ways to reduce infusion site reaction with CSCI pumps
Dilute with more water
Add dexamethasone 500 micrograms - 1mg
Changing site more often
Plastic cannula if there is concern about a nickel allergy
Applying hydrocortisone cream to the site
Which drugs are commonly associated with local skin reactions?
Levepromazine
Cyclizine
Which drugs are not suitable for CSCI use?
Chlorpromazine
Diazepam
Prochlorperazine
When should deaths be referred to coroner?
Suicide
Cause unknown
Suspiscious/violent circumstances
Accidental injury
Industrial disease
Neglect/self harm
Dr not in attendance in last 28 days
Creutzfeld-Jakob disease
Prisoner/in state detention
