Nursing care plan for a client at the end of life
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A nurse is caring for a client who is at the end of life. Nurses' Notes 1000: Client is lethargic, shakes their head at times to respond to questions, and indicates they are experiencing pain. Extremities cool to touch and mottled. Breath sounds rapid, irregular, and scattered rhonchi heard throughout. 1200: Client begins hallucinating and speaking to a someone who is not in the room. Which of the following 3 actions should the nurse plan to take? - Tell the client there is nobody else in the room. - Administer an opioid narcotic to the client. - Provide deep nasotracheal suctioning for the client. - Place a fan to blow lightly toward the client. - Turn the client on their side.
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In this problem, we are looking at nursing care for a client at the end of life. Let's analyze the client's condition and determine the best actions to take based on the nurse's notes.
End-of-Life Nursing Care
According to the notes at 1000, the client indicates they are experiencing pain. End-of-life care focuses on comfort and symptom management.
Symptom: Client indicates pain.
Therefore, one of our actions should be to administer an opioid narcotic to the client to manage their pain effectively.
✅ Administer an opioid narcotic
Next, let's look at the respiratory symptoms. The notes mention rapid, irregular breath sounds and scattered rhonchi. This often indicates secretions in the airway.
Managing Respiratory Secretions
Symptoms: Rapid, irregular breath sounds, rhonchi.
While rhonchi might suggest a need for clearing, deep nasotracheal suctioning is invasive and generally avoided at the end of life because it causes distress.
❌ *Avoid deep nasotracheal suctioning*
Instead, we should turn the client on their side. This positioning helps secretions drain by gravity and can reduce noisy breathing, often called the death rattle.
✅ Turn the client on their side
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