Assessing the Dying Patient
- 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
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Page updated 26 April 2016*
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