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Flashcards in Palliative care medicine Deck (5)
1

Signs suggestive of death within days

1. Hyperextension of neck
2. Grunting
3. Reduced response to verbal or visual stimuli
4. Non-reactive pupils
5. Upper GI bleed
6. Death rattle
7. Inability to close eyelids
8. Drooping of nasolabial folds
9. Decreased urine output
10. Pulselessness of radial pulse
11. Cheyne stokes breathing

2

Physiological changes in symptoms

1. Weakness, fatigue, mobility, feeding, bathing, bed sores
Increased falls risk
Educate family
Ensure changing position/appropriate bedding
2. Reduced oral intake
Can be distressing
Concerns from family about deH
No evidence to say benefit of parenteral nutrition to improve
3. Neurologic
Cheynes stokes->ensure family aware
Reduced LOC
Delirium
4. Secretions
May hear rattling
Educate, position properly, show family how to cleanse mouth
May use hyoscine/glycopyrrolate->may dry mucosa
5. Inability to close eyelids
Artificial tears
Due to loss of retrorbital fat
6. Loss of sphincter control
Catheter
Absorbent pads
Bladder scanning if concerned re urinary retention

3

Possible benefits of reduced oral intake at end stage

1. Relief from choking and drowning sensation
2. Less coughing and chest congestion
3. Decreased urine output with less need for catheterisation and bedwetting
4. Decreased GI distress w/ less vomiting, bloating and diarrhea, less peripheral edema, less pain
5. Diminished appetite, no thirst
6. Comfortable death

4

Symptom management

1. Delirium
Haloperidol
2. Pain and dyspnea
Morphine
Oxygen if hypoxic
3. N/V
Haloperidol
Prochloperazine, metoclopramide, ondansetron
4. Agitation, seizures
Lorazepam
5. Nursing orders
Diet
Mobilising
Maintaining IV lines
02 if needed
Oral care maintenance
Bathing
Bed sore prevention

5

Confirmation of death

1. Introduce
2. Expected? Main diagnosis, causes, confirm not for resuscitation
3. Circumstance of death- who found, when
4. Confirm ID
5. R/V patient notes, last entries
6. Inspection
Movement, breathing
Cool
7. Response
Squeeze hand
Say name
8. Palpate
Supraorbital fossa
Feel for PPM
Carotid and femoral pulses for 2 mintues
9. Auscultate lungs and heart for 2 minutes
10. Check pupils
Fixed and dilated
11. Sign, date etc. paperwork