Geriatric considerations - End-of-life care: Nursing

End of life care involves the supportive care provided to an individual. As the near death.

As the nurse you'll provide end of life care for older adults by recognizing and managing the physiologic changes that occur at the end of life and providing emotional support for the patient and their family.

Now, there are certain physiologic changes that occur during the dying process. Starting with the cardiovascular system.

These changes are mostly related to diminishing cardiac output and BP. As a result, heart sounds become faint, peripheral pulses weaken and circulation slows.

Subsequently, the skin becomes cool pale and mottled with bluish coloring known as cyanosis, especially in the extremities.

Next, in the respiratory system, patients often report feelings of dyspnea including a feeling of chest tightness or breathlessness, which is due to factors like respiratory congestion and weakened respiratory muscles.

Keep in mind that patients experience dyspnea, even when typical signs like decreased oxygen saturation or rapid breathing are not observed.

Other respiratory changes include slow and irregular respirations, often with Shane Stokes, respirations which are alternating episodes of apnea and hyperventilation.

Patients may also develop distinctive wet gurgled, noisy breathing called the death rattle, which is caused by saliva and mucus building up in the back of the throat and upper airways.

Ok. Moving on to the neurologic system, decreased cerebral perfusion and metabolic disturbances can result in acute episodes of confusion or delirium, which can alternate with moments of lucidity.

Other symptoms include agitation, excessive sleepiness or insomnia. They can also have sensory changes like diminished sight, visual hallucinations and hypersensitivity to light and sound.

Although hearing typically remains intact up until the moment of death as death nears responsiveness decreases and they eventually lose consciousness altogether.

Now, patients may also experience debilitating pain which can interfere with their ability to cope at the end of life. Pain can be related to the disease process itself or treatment potentially leading to severe fatigue, depression changes in appetite and even acceleration of death.

Concerning pain can interfere with communication and interaction with loved ones during this crucial time. Lastly, the gastrointestinal system slows down and anorexia or loss of appetite is common.

Anorexia is related to a variety of factors such as nausea and vomiting changes in taste, oral ulcers and even emotional factors like depression.

As a result, patients can experience xerostomia or dry mouth, dehydration, decreased weight and muscle wasting, known as cachexia.

Other gastrointestinal symptoms can include abdominal distension, intestinal obstruction, constipation or bowel incontinence.

As the nurse caring for an older adult at the end of life, you'll identify and manage physiologic symptoms and provide emotional support.

Begin by identifying system specific symptoms and address them as needed for patients experiencing cool extremities from decreased circulation, adjust the room temperature for comfort and provide blankets and socks as needed.

If your patient has respiratory difficulties, elevate the head of the bed and increase ventilation in your patient's room by opening windows or turning on a circulating fan, creating a quiet environment and providing music can help reduce anxiety related to respiratory difficulties.

Other patients may benefit from supplemental oxygen. For those with severe respiratory distress, administering the prescribed morphine can promote pulmonary vasodilation and ease the work of breathing.

Next, measure your patient's level of pain or discomfort if they are unable to communicate. Take note of nonverbal signs like moaning, grimacing, irritability or restlessness.

You can use non pharmacologic approaches to pain management by ensuring your patient's environment is calm and relaxing, minimize loud noises and disruptions and by using imagery or visualization techniques, reposition them regularly and alternate periods of activity with rest to minimize fatigue, then be sure to administer the prescribed analgesics to manage pain and evaluate the effectiveness of your pain management interventions.

Now, if your patient has an appetite, ask about their food and drink preferences and encourage their family to bring in favorite items from home.

You may also administer antiemetics for nausea, laxatives for constipation or artificial feedings if indicated as oral intake declines, keep your patient's mouth moist with ice chips and lip balm and perform oral care regularly.

As far as emotional support goes, you'll provide support for your patient and their family by allowing them to verbalize fears and concerns as well as share fond memories about their loved one.

Keep in mind, religious and cultural beliefs can affect how a person responds to death. So be sure to gather information to address their individual needs.

Lastly, collaborate with the palliative care specialist as indicated. All right.

As a quick recap, end of life care involves the supportive care provided to an individual as they near death. As the nurse you'll provide end of life care for older adults by recognizing and managing the physiologic changes that occur at the end of life and providing emotional support for the patient and their family.