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Assessing the Dying Patient

Key points

  • Recognising dying is the first step in terminal care management. If three or more of the following symptoms are present is likely the patient is entering the terminal phase.
    • ​Experiencing rapid day to day deterioration that is not reversible
    • Requiring more frequent interventions
    • Becoming semi-conscious, with lapses into unconsciousness
    • Refusing or unable to take food, fluids or oral medicines
    • Irreversible weight loss
    • An acute event has occurred, requiring revision of treatment goals
    • Profound weakness
    • Changes in breathing patterns
       
  • ​The duration of the terminal phase is hard to predict. It can range from short hours to many days. The family should be advised of this.
    • ​Cachexia, end-stage organ failure, or infection may be associated with a more rapid deterioration
    • Patients may survive for some days, even without fluids.
       
  • In patients with severe dementia and similar end-stage chronic conditions affecting the conscious state, it may be quite difficult to clearly identify the onset of the terminal phase.
     
  • The clinical priorities at this stage are:
    • Talk to patient and / or family
    • Address symptoms
    • Ensure needed medications are available
    • Advise other health professionals
    • Consider whether the patient is in residential aged care or at home, or if they have expressed a preference for admission to hospital or palliative care unit for end of life, and plan accordingly

Tools and Resources for professionals

Recognising death - Podcast
RACP - Royal Australasian College of Physicians
 
This is the first of three podcasts addressing end of life issues. 
 
This episode includes interviews with Dr Peter Saul, A/Prof Charlie Corke, and A/Prof Amanda Walker, talking about why and how we need to identify dying patients
 
Includes links to some of the resources discussed during the podcast.
Ref: Royal Australasian College of Physicians – Pomegranate.  31st August , 2015.
For more information, pomcast@racp.edu.au.

Pomegranate comes to you from the Learning Support Unit at the Royal Australasian College of Physicians. The program is presented by Camille Mercep and produced by Anne Fredrickson.


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Page updated 26 April 2016*