Symptoms at the end of life: pain, breathlessness, secretions, delirium and mouth care
- Fundamental
Nursing assesses and relieves end-of-life symptoms with simple measures and the treatment the team orders, without waiting for them to get worse.
What it is
At the end of life, symptoms appear that cause suffering: pain, breathlessness (dyspnoea), noisy secretions, delirium, anxiety, nausea, constipation, fatigue and a dry mouth. Nursing assesses them often, applies non-drug measures, and gives and monitors the treatment the doctor orders, per protocol. The goal is comfort as the patient defines it, for example staying alert to talk with the family. This page names no drugs and no doses.
Key points
- Up to 90% of patients at the end of life may develop delirium.
- Terminal secretions are usually noticed about 3 to 23 hours before death.
- Fatigue is described as the most disabling symptom in palliative care.
- Constipation goal: at least one bowel movement every 72 hours, matched to the patient's usual pattern.
- WHO lists access to opioids for pain and breathlessness among the essential components of palliative care.
Components
- Pain: a numeric scale if the patient can answer; a behavioural scale if not.
- Breathlessness: severity from 0 to 10, ability to speak, anxiety and work of breathing.
- Delirium: an acute change in attention and awareness; get a baseline from the family.
- Mouth: dryness, sores, odour and difficulty swallowing.
What it is for
- Detect a new or worsening symptom early.
- Choose comfort measures the patient accepts.
- Give the team concrete data to adjust treatment.
Step by step
- Assess each symptom with a scale and record it — shows whether the measures work.
- Breathlessness: raise the head of the bed, use a fan or open a window and keep the room cool and calm — eases the feeling of air hunger.
- Secretions: turn the patient onto their side and explain the noise to the family — suctioning rarely helps and agitates the patient.
- Pain: give the ordered analgesia on time and reassess — relief is balanced against how alert the patient wants to be.
- Delirium: reorient, ask the family to stay, keep soft light and tell the doctor — there may be a reversible cause, such as a drug.
- Mouth: clean and moisten the mouth and lips often — prevents dryness, pain and sores.
- Nausea and appetite: offer small portions of favourite foods at room temperature, without strong smells — eating is for pleasure, not a duty.
- Anxiety: use guided breathing, music, presence and clear information — fear of the unknown worsens anxiety.
In nursing practice
- The family may see food as a way to «get better»; listen, and explain that forcing food can cause more discomfort.
- Watch for oversedation, falls and delirium when anxiety medications are used, especially in frail older adults.
- New breathlessness from an acute cause is reported to the doctor at once.
- If a symptom does not respond to any measure, the team may consider palliative sedation, with consent and documentation.
Common mistakes
- Routinely suctioning terminal secretions.
- Withholding or delaying pain relief for fear of respiratory depression.
- Assuming there is no pain because the patient does not complain.
- Forgetting the mouth: dryness causes a lot of distress and is easy to relieve.
Test yourself
Think of the answer, then tap the question to see it.
How is pain assessed in a patient who can no longer speak?
With behavioural signs, such as facial expression, moaning and posture, and with their earlier pain history.
Why is routine suctioning of terminal secretions not recommended?
Because it is usually ineffective and increases agitation; turning the patient onto their side works better.
What is the most common cause of delirium at the end of life?
Medications, followed by metabolic failure from organ failure.
Which non-drug measures ease breathlessness?
Raising the head of the bed, a fan or an open window, pursed-lip breathing and a cool, calm room.
What does the rule of double effect say?
That relieving pain and suffering is morally justified even if it might shorten life, when the intention is relief.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing Fundamentals, 17.4 Palliative Care Management (Open RN, Wisconsin Technical College System (LibreTexts), 2021); Nursing Fundamentals, 17.5 Nursing Care During the Final Hours of Life (Open RN, Wisconsin Technical College System (LibreTexts), 2021); Palliative care (fact sheet) (World Health Organization, 2020).
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Representative model, for educational purposes only.