Welcome Overview Pain Management Symptom Management Common Symptoms: Bowel Management Nausea and Vomiting Fatigue Fatigue Terminal Phase Changing Awareness Withdrawal Pain Altered Elimination Respiratory Changes Agitation or Restlessness Signs of Impending Death Caregiver Support
		The Terminal Phase of Illness Terminal Agitation or Restlessness A patient may become restless, unable to lie still or even attempting to get out of bed, arguing with caretakers, and becoming confused to the point of agitation in end-stage disease process. Even if their pain seems well controlled, the patient may change positions frequently and voice unspecified discomfort. A thorough assessment must be performed to rule out pain, bladder distension, constipation, etc. as a cause of the agitation, and medications reviewed. Once physical causes have been ruled out, the caregivers need to be educated on the changes that are occurring in the patient physically and mentally. As the body’s systems begin to shut down and the kidneys and liver no longer function properly, there is a build-up of waste products from the cells and tissues in the bloodstream. The delicate chemical balance maintained by the normal feedback loops in the various body systems is lost. Care must be taken to keep the patient safe and educate the family, as the agitation can be very distressing to them. Treat the underlying cause if appropriate; medications such as midazolam, chlorpromazine, haloperidol or barbiturates may then be used. Consider switching opioids and eliminate medications that are not necessary.