Z51.1
DESCRIPTION
Patients can be defined as being terminal when there is irreversible decline in functional status prior to death. It is essential during this time to ensure the ethical management of the dying phase and to minimise distress for the patient, family and fellow health care professionals by using a biopsychosocial and spiritual approach.
Signs of dying:
- The patient may gradually spend more time sleeping during the day and at times will be difficult to rouse.
- There may be decreased need for food and drink.
- The patient may become increasingly confused about time, place and identity of friends and family.
- Arms and legs may become cool to the touch and the undersides of the body may become darker in colour.
- Loss of control of bowel and bladder may occur.
- Urine output may decrease.
- Saliva and mucus may collect at the back of the throat as the swallowing and cough reflexes diminish. This sometimes causes a noise known as the “death rattle”.
- Vision and hearing may decrease.
- Breathing patterns may become irregular, with longer intervals between breaths.
GENERAL MEASURES
Communication is at the centre of care. The following aspects should be addressed:
- Honest, direct, compassionate and culturally sensitive information about the prognosis.
- Evaluation of the patient and family resources and needs, especially spiritual needs.
- Decision making on place of death as many patients want to go home.
- Education about patient care.
- Emergency contact details, especially if the patient wants to go home.
- Compassionate information about symptoms that might develop and how to manage them.
- Nutrition and hydration.
Discontinue all non-essential, futile procedures and medicines e.g. discontinue 4-hourly blood pressure measurements and vitamin tablets.
Ensure medicines are prescribed for symptom management and prescribe medicine when needed to pre-empt common symptoms during the terminal phase using the appropriate route of administration:
- Pain (see section above)
- Nausea and vomiting (see section above)
- Respiratory secretions (see section above)
- Agitation /restlessness/delirium (see section above)
Discuss feeding and hydration with the family. If the decision is to hydrate and/ feed, ensure gentle hydration and monitor oedema, especially in patients with hypoalbuminaemia. Hydration does not improve quality of life, survival, or symptom burden at the end of life, and should not be given as routine management. Rather offer sips of water if the patient is able to swallow.