D4 · Distressing symptoms near death
Actual End of life
Definition
Breathlessness, agitation, pain, or secretions cause distress near the end.- Advanced disease
- secretions
- organ failure
- Noisy breathing
- agitation
- pain
- nausea
📋 Scenario
A patient has rattling breaths and is restless.
Subjective (S): (Unable to speak.) Rattling breaths.
Objective (O): Noisy breathing; agitated; observed pain 7/10; poor intake.
Assessment tools for this scenario: CP-END End-of-Life Comfort Check CP-PAIN Pain & Comfort Score
Validated scales to consider: ESAS, NRS 0–10, FLACC, PAINAD
**CarePath diagnosis:** Distressing symptoms near death related to advanced disease, as evidenced by noisy breathing and agitation.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Give comfort medicines as ordered. | Medicines for pain, breathlessness, agitation and secretions, given as ordered, relieve distress quickly when he cannot ask for help himself. |
| Reposition. | Changing position helps secretions drain and eases pressure and discomfort, though movement should be gentle to avoid worsening pain. |
| Give mouth care. | Mouth care keeps the mouth moist and clean, which relieves dryness and discomfort that he cannot report. |
| Keep calm. | A calm, quiet environment lowers agitation and helps him rest more comfortably. |
| Reassure the family. | Explaining that noisy breathing is usually not painful to the patient, and what is being done, eases the family's fear and distress. |
**Expected outcomes**
- Calm and comfortable.
- Secretions managed.
- Family reassured.
- No distress.
**Linking the data to the diagnosis**
This is an actual problem because distress is already present. The patient cannot speak, has rattling breaths, noisy breathing, agitation and observed pain 7/10, and intake is poor. Because he cannot say how he feels, the nurse relies on what is seen and heard. This fits better than a general comfort need because specific symptoms need targeted relief. The plan gives comfort medicines as ordered, repositions, gives mouth care, keeps the room calm and reassures the family. The aim is that he is calm and comfortable, secretions are managed, the family is reassured and there is no distress.
CarePath diagnosis
Distressing symptoms near death related to advanced disease, as evidenced by noisy breathing and agitation.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Give comfort medicines as ordered. | Medicines for pain, breathlessness, agitation and secretions, given as ordered, relieve distress quickly when he cannot ask for help himself. |
| 2. Reposition. | Changing position helps secretions drain and eases pressure and discomfort, though movement should be gentle to avoid worsening pain. |
| 3. Give mouth care. | Mouth care keeps the mouth moist and clean, which relieves dryness and discomfort that he cannot report. |
| 4. Keep calm. | A calm, quiet environment lowers agitation and helps him rest more comfortably. |
| 5. Reassure the family. | Explaining that noisy breathing is usually not painful to the patient, and what is being done, eases the family's fear and distress. |
Expected outcomes
- Calm and comfortable.
- Secretions managed.
- Family reassured.
- No distress.
Linking the data to the diagnosis
This is an actual problem because distress is already present. The patient cannot speak, has rattling breaths, noisy breathing, agitation and observed pain 7/10, and intake is poor. Because he cannot say how he feels, the nurse relies on what is seen and heard. This fits better than a general comfort need because specific symptoms need targeted relief. The plan gives comfort medicines as ordered, repositions, gives mouth care, keeps the room calm and reassures the family. The aim is that he is calm and comfortable, secretions are managed, the family is reassured and there is no distress.