Pain Management

Symptom Management
Common Symptoms:
Bowel Management
Nausea and Vomiting
Terminal Phase
Changing Awareness

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.