Last 48 hours 

It is important physicians are able to recognise the signs and symptoms associated with the

final stages of life so patients are not subjected to further invasive procedure or

investigations. If the prognosis of the patient is uncertain, clinicians should be honest and

discuss this matter with the family so false hope is minimised.

 

The common symptom observed in patients reaching the terminal stages of life is:

•  Increased immobility

•   Difficulty swallowing

•  Lowered intake of food and drink

•  Drowsiness or semicomatose

•  Difficulty breathing

•  Confusion

 

Principles

•  The priority in this latter stage is withdrawal of unnecessary interventions such as

antihypertensives,corticosteroids, hypoglycaemics and antidepressants previously essential

in the treatment of the patient.

•  Alternative medications (analgesic, anticonvulsants,

antiemtics and sedative) should be considered to relieve uncomfortable symptoms including

pain, breathlessness, delirium and restlessness.

•  Good communication with the relatives is vital at this phase because the concept of discontinuing nonessential medicine may caus fear and anxiety amongst the family. Therefore discussion with the family is vital before

withdrawing certain medications.

•  Furthermore as a consequence of the swallowing reflex diminishing near death, the use of

the oral route for the delivery of medication may no longer be viable and alternative routes

such as subcutaneous, sublingual, transdermal and rectal route should be considered.