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Difficulty: HardEnd of Life Care

A home hospice nurse is managing the care of a client in the final days of life. The client is unresponsive with Cheyne-Stokes respirations and peripheral mottling. The client's spouse is visibly distressed and demands, 'You must start an IV line for hydration. It is cruel to let him dehydrate to death.' Which of the following actions are appropriate for the nurse to take? Select all that apply.

  1. Educate the spouse that natural dehydration decreases respiratory secretions and can promote a more peaceful passing.Answer
  2. B
    Request a prescription for a low-rate continuous intravenous normal saline infusion to ease the spouse's anxiety.
  3. C
    Tell the spouse, 'I know this is hard, but starting an IV will only prolong the dying process.'
  4. Elevate the head of the bed and position the client on their side to facilitate the drainage of oral secretions.Answer
  5. E
    Delegate the task of auscultating the client's lung sounds to the unlicensed assistive personnel (UAP) to monitor for congestion.
  6. Apply artificial tears to the client's eyes and gently swab the oral cavity with moisture every few hours.Answer

Answer

The appropriate actions are to educate the spouse about the benefits of natural dehydration, position the client to facilitate secretion drainage, and provide meticulous oral and eye care.
The correct nursing actions prioritize the client's physical comfort and the family's psychosocial needs. Educating the spouse that natural dehydration is a normal and beneficial part of the dying process helps reduce the 'death rattle' and promotes endorphin release. Physical comfort is maintained by positioning the client on their side with the head elevated to drain secretions and by providing regular eye and oral care to prevent drying and breakdown.

Step-by-Step Solution

1
Analyze the client's physiological state.
The client is in the active phase of dying, characterized by unresponsiveness, altered breathing patterns, and decreased peripheral perfusion.
Understanding the clinical phase determines the appropriate goals of care, which shift strictly to comfort rather than curative or life-prolonging measures.
2
Evaluate the spouse's request for artificial hydration.
Artificial hydration is contraindicated. As the body shuts down, it cannot process excess fluids, which leads to pulmonary edema, increased respiratory secretions (death rattle), and peripheral edema.
Natural dehydration stimulates endorphin release which promotes comfort, whereas IV fluids can cause significant physical distress.
3
Identify therapeutic nursing interventions.
The nurse must provide physical comfort (oral care, positioning) and psychological support (evidence-based education regarding the dying process) while avoiding non-therapeutic communication or inappropriate delegation.
Palliative and hospice care prioritize maximizing quality of life, managing symptoms, and supporting the family unit without accelerating or delaying death.

Key Concept

Management of physiological changes and family dynamics during the active phase of dying.
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Topics

End of Life Care

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