The nurse’s task in Esther’s case is to review how the team assess and manage patients’ symptoms in end-of-life care. Due to the effects of stroke there may be particular challenges which the team should be aware of e.g. hemiplegia, aphasia and cognitive problems. These stroke specific complications can make it more challenging to assess and manage end-of-life symptoms. All care should be tailored to the individual and highlighted in their care plan.
For further information on symptom management in end-of-life care:
- Scottish Palliative Care Guidelines
- & see the Additional Information box below
Swallowing
Dysphagia complicates the management of oral care and aspiration can increase respiratory complications. Regular assessment of swallowing ability can guide best management. Always provide oral care.
General end-of-life symptoms/issues – anxiety, nausea/vomiting, dyspnoea and mouth dryness.
Physical impairment
Pain management, respiratory care and positioning should all take account of the patient’s physical impairments such as hemiplegia.
General end-of-life symptoms/issues – constipation, dyspnoea, and pain.
Type of stroke
Intracranial haemorrhage and infarction with cerebral oedema may lead to increased intracranial pressure and cause cerebral irritation. This may influence the choice of medication. Patients may also appear restless or agitated.
General end-of-life symptoms/issues – dyspnoea, confusion, agitation, nausea/vomiting, and pain.
Site of lesion
For example, a posterior circulation stroke may present with dizziness, nausea and vomiting. This may influence the choice of anti-emetic.
General end-of-life symptoms/issues – anxiety, confusion, constipation, agitation, nausea/vomiting, dyspnoea, mouth dryness, and pain.
Understanding
Aphasia or cognitive impairments which reduce the patient’s ability to understand will affect the provision of information and reassurance. Strategies to support communication should be used e.g. gesture, pictures.
General end-of-life symptoms/issues – anxiety, confusion, agitation, and pain.
Communicating
When aphasia or dysarthria result in a patient being unable to communicate their needs and concerns, this can affect the assessment of all symptoms. Note should be taken of non-verbal signs and further investigated e.g. grimace.
General end-of-life symptoms/issues – anxiety and pain.
Page last reviewed: 08 Nov 2021
