A client receiving hospice care at home begins to exhibit loud, rattling respirations. The client's family members are crying and express concern that the client is choking. In which order should the practical nurse implement the following actions? Arrange the steps from first (highest priority) to last.
- 1Reposition the client into a side-lying position with the head of the bed elevated.
- 2Administer the prescribed as-needed anticholinergic medication.
- 3Perform gentle, shallow clearing of pooled secretions from the oral cavity.
- 4Provide oral hygiene and apply a water-soluble lubricant to the lips.
- 5Explain to the family that the noisy breathing is a natural part of the dying process and does not cause pain.
Answer
The correct sequence is to first reposition the client, then administer the anticholinergic medication, gently clear oral secretions, provide oral hygiene, and finally educate the family.
When managing terminal secretions (often referred to as a 'death rattle'), the nurse must prioritize interventions from least invasive physical measures to pharmacological treatments, followed by hygiene and psychosocial support. Repositioning uses gravity to immediately clear the airway without causing distress. Administering an anticholinergic medication treats the root cause by drying up ongoing secretions. Gentle oral clearing removes already pooled fluids, followed by oral care for mucosal comfort. Once the client's physical comfort is stabilized, the nurse must educate the distressed family to reduce their anxiety, as the sound is often more distressing to loved ones than to the dying client.
Step-by-Step Solution
Key Concept
Prioritization of Terminal Secretions (Death Rattle) Management