Last hours of living
Section snippets
Advance preparation
Care during the last hours of life is a core competency of every physician and health care worker [4], [5], [6]. People who know what to expect have a different experience of dying and death than people who are ignorant of the process. Time spent preparing patients, family members, and caregivers for the end of life helps to reduce anxiety and fear; increase competence and confidence to provide care; increase the sense of value and gifting during the process; create good memories of the
Managing the dying process
As the last hours of life evolve, the many common, irreversible signs and symptoms can be alarming if not understood by the family (see Box 1). Reassess the need for every therapeutic intervention. Stop medications and therapies that are inconsistent with the patient's goals of care. Give only medications needed to manage symptoms (eg, pain, breathlessness, terminal delirium, secretions, seizures) (Table 2). Base pharmacologic and nonpharmacologic management on the etiology and underlying
When death occurs
When the expected death occurs (see Box 1), the focus of care shifts from the patient to the family and caregivers (see Box 2). Everyone has a different experience and a personal sense of loss. Even though the death had been anticipated for some time, no one knows what the loss feels like until it actually occurs. To help them address their acute grief, encourage family members and caregivers to spend as much time as they need with the body. It may take hours, days, weeks, or even months for
Bereavement
Immediately after a death, bereaved individuals need time to recover from the acute stress and fatigue and to restore their environments to a more normal state. As they begin to realize the significance of the loss and its impact on their lives, they are likely to experience an intense grief reaction with multiple cognitive, emotional, and physical responses (Table 3), and they may require considerable ongoing support to help them deal with all the changes [58], [59], [60], [61], [62]. Some
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Ventilator Withdrawal in Anticipation of Death: The Simulation Lab as an Educational Tool in Palliative Medicine
2020, Journal of Pain and Symptom ManagementSymptom Expression in the Last Seven Days of Life among Cancer Patients Admitted to Acute Palliative Care Units
2015, Journal of Pain and Symptom ManagementCitation Excerpt :All clinicians who participated in this study provided written informed consent before patient enrollment. We identified target symptoms for this study by conducting a literature review of published articles8,9,15,16 and educational materials,17 and discussing relevant variables with participating palliative care clinicians. The symptoms were collected from patients who were able to communicate verbally and interact with our staff.
Palliative care, hospice and end of life
2012, Management of Cancer in the Older PatientPalliative care, hospice and end of life
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2009, Annals of Emergency MedicineCitation Excerpt :It may also help avoid doubts about aggressive interventions once the decision has been made to forgo these efforts. Natural death from chronic incurable illness is characterized by changes in neurologic, respiratory, circulatory, and muscular function, resulting in laboratory and vital sign abnormalities that culminate in low blood pressure, slow breathing, and apnea.69 Patients and their families should be encouraged to comfort one another during this process, by the presence and guidance of the multidisciplinary team in the ED, including physicians and nurses, but especially by the chaplain and social worker.
End-of-life care for older adults
2005, Primary Care - Clinics in Office PracticeCitation Excerpt :The individual's ability to distribute, metabolize, and use drugs may be rapidly impaired, and rapid changes also occur in physiologic parameters. Anticipatory treatment provides the most effective symptom management during the active dying process [33]. All nonessential medications and treatments should be stopped, and for those that are continued, the route of delivery should be re-evaluated.