How does someone die of a burn

Palliative phase> symptoms

1. The most important things in a nutshell

There are a number of symptoms that can appear especially in the last phase of life. Only the most common symptoms are listed below in order to give patients and relatives an orientation. It helps many to know that the increasing difficulties that arise now are not unusual and at the same time treatable. Symptoms like anxiety, depression, insomnia, and restlessness are common: they are also quite natural given the fact that life is coming to an end.

2. Relief from Symptoms

There are many aids that can help the symptoms alleviate can. Patients and family members should speak to the doctor, caregivers, and hospice workers. Only when the specialists know about the complaints can they seek remedial action. In addition to effective medication, there are many nursing and supportive measures with which nursing services, hospice helpers and relatives can relieve and enable a life in dignity to the end.

2.1. Practical tip

A layman-understandable overview of the most important symptoms and medication can be downloaded from the German Palliative Foundation at www.palliativstiftung.de> Publications> Books / Brochures / Advice> Medication Tips.

3. Acute confusion (delirium / delirium)

Within a very short period of time, symptoms such as confusion, aggressiveness, delusions, rapid changes of feeling and a disturbed sleep-wake cycle can occur temporarily in a palliative patient. The person concerned no longer knows where he is and what is happening around him.

A state of confusion is usually not permanent and disappears after a few hours, but sometimes the state can last until death. In older patients, it can also be an age-related confusion such as dementia.

There are several signs that a palliative patient is in a state of confusion:

  • He is disoriented, unfocused and often does not know where he is.
  • Answers to questions often seem incoherent and nonsensical.
  • Phases of clarity and confusion alternate abruptly.
  • Disturbed sleep-wake rhythm.
  • He looks irritable, angry, but also anxious and depressed.
  • Hallucinations occur.

The triggers can be very different and depend in part on the type and severity of the disease. Adequate hydration (or infusions), personal attention, and relaxation exercises can help. However, it can also make sense to use medication that can help over critical situations in the short term.

4. Fear

Fear of the end of life and of dying is common and has a variety of causes. Conversations about fears are important and can be very helpful. Relatives and friends can listen and be there. There are also caring measures or activities that calm and / or distract.

Fear triggers can also be old conflicts, "open accounts". Sometimes an uninvolved third party can help better as a conversation partner, e.g. a hospice helper or pastor.

If there are very specific fears, e.g. of pain, of the progression of the disease, of losing independence, doctors and nurses are good contacts. You know developments in other patients and can use information to resolve fears. If the fear is very strong, they also know the medication that can help against it.

5. Loss of appetite

In the palliative phase, hunger and thirst sometimes completely disappear, and great care is required to deal with these situations correctly. "Correct" means: as the patient wishes, as it is right for him.

Some people don't want to eat or drink at the end of their lives. That is natural - but difficult for the relatives to bear. To acknowledge that a loved one no longer wants to eat, that is, to accept that they will not live long.

If a person still wants to eat and drink, they should take what they want: Joy of life is more important than nutritional knowledge in the palliative phase. But there must be no compulsion to eat and drink.

If food is difficult to eat, the food should be as rich in protein and calories as possible. In some cases, artificial feeding (enteral or parenteral) or fluids may be appropriate, e.g. if nausea, pain, weakness, difficulty swallowing or other symptoms make eating difficult or impossible. Artificial nutrition should only be carried out if the patient so wishes and it is medically indicated. The attending physician decides on the medical indication.

6. Difficulty breathing (dyspnoea)

Shortness of breath is one of the most distressing and threatening symptoms because it often triggers the fear of suffocation.

Shortness of breath arises not only when there is a lack of oxygen, but also when there is too much carbon dioxide in the body, which cannot be exhaled. Reasons for this can be, for example, respiratory diseases, heart problems, weakness or nervousness. Fear flattens breathing - and the shortness of breath becomes even greater.

In the event of breathlessness, it is therefore important to calm the patient down and focus on breathing as evenly as possible. Fresh air or a fan can help.

Difficulty breathing can also be relieved with medication.

7. Depression

It is normal for an incurable illness, distressing symptoms, and the approaching end of life to depress mood. This means that those affected do not immediately suffer from depression, which must be treated with medication.

However, if symptoms such as depressed mood, insomnia, hopelessness, decreased interest and low drive are pronounced and persist for a long time, the doctor should be informed. Antidepressants can contribute to an increase in the quality of life here, but their prescription must be carried out carefully with a view to interactions and side effects (for details see Depression> Treatment). However, some side effects are also desirable, e.g. antidepressants can relieve certain pain.

8. Itching (pruritus)

Itching is a rare but very painful symptom. Itching is relatively common in liver damage, dry skin and skin changes, but there are other and often very complex causes.

It is important not to scratch when itching: scratching injures the skin and increases itching. Relief can e.g. press, cool and any form of distraction.

Good skin care is important: Here you should seek advice from qualified nurses, because everything should be optimally adjusted to the skin type and the patient's well-being: the washing lotion, the washing temperature, drying (do not rub), the skin care product, the clothing, the room temperature , the humidity, the food and drink.

There are also anti-itch drugs that are used when care measures do not help.

9. Powerlessness and total weakness (fatigue)

After a long life-threatening illness and many treatments, the body and psyche will eventually reach their limits. Sometimes this is the natural process and a person is at the end of his or her strength and no longer wants to live. This is a difficult situation for the relatives, but it should be respected.

There are also cases in which the body no longer has any strength after intensive therapy or symptoms prevent eating, drinking and sleeping and thus lead to increasing weakness and emaciation (cachexia). In these cases, artificial nutrition can help. If medication is causing the weakness, a doctor should discuss how to proceed.

10. Seizures

Seizures only last a few seconds to minutes, but they are stressful for the patient and often associated with fear and shame. Relatives are often very unsettled by the attacks and feel helpless.

Seizures often occur in patients with brain damage, e.g. after a traumatic brain injury, or after surgery on the head or radiation. They can also develop with brain metastases or with increased intracranial pressure. They are not to be confused with epilepsy.

In the event of a seizure, the doctor should be informed as soon as possible: he will then usually prescribe medication for it.

11. Mouth fungus (thrush, candidiasis)

Palliative care patients often have a whitish coating in the mouth that burns and hurts when eating and drinking. That can be mouth fungus. Fungi can be found practically everywhere, but palliative care patients are particularly vulnerable because their immune system is weakened or the mucous membranes are attacked. Often this is a consequence of chemotherapy in cancer patients.

Consistent oral care helps against fungal infections in the mouth - preferably preventive. A healthy oral mucosa prevents the colonization of fungi. If the mouth fungus is already there, it is essential to treat it. It is harmless in the mouth, but if it spreads it can attack organs and be life-threatening, especially in old, weakened people.

Mouth cleaning and oral care are very intimate. If a patient is too weak to do it on his own, it should be done very carefully and considerately. It is ideal if people close to you do so.

12. Insomnia

Sleep disorders are very common in patients: some cannot sleep because they have complaints or worries that concern them; or because they just lie down and don't tire. Others are "just tired" and exhausted, see also under weakness. Some patients cannot fall asleep, some cannot sleep through the night, some sleep during the day but not at night, and others have difficulty waking up in the morning.

As different as the forms of sleep disorders are, the causes can also be complex. There are medications for sleep disorders, but they are only useful if the sleep disorders are very stressful. Under no circumstances should palliative care patients, who usually take several medications, take sleeping pills without consulting a doctor.

If symptoms such as pain or nausea prevent falling asleep or staying asleep, these must be treated as a matter of priority.

Often, however, nursing and supervisory measures also help, e.g .:

  • Accepting that the body gets “out of step” at the end of life
  • Soothing conversations, reading, music
  • Aromatherapy with soothing essential oils
  • Soothing teas, e.g. lemon balm tea
  • Activity during the day so that tiredness comes in the evening
  • Fall asleep rituals, e.g. prayer, relaxation exercises

More tips under sleep hygiene.

13. Pain

Pain is the most common and often the worst symptom for patients. Then there is the fear of pain. Pain can be alleviated very well today. Experienced pain and palliative medicine specialists manage to achieve a tolerable and often pain-free state for a large number of patients.

Sometimes there is only inadequate pain therapy. There can be different reasons:

  • Some patients and relatives believe that suffering is "normal" and must be endured. But the last lifetime is precious. You don't have to endure pain.
  • In the face of a weakened body, pain can be very complex with multiple or serious illnesses. Therapy is correspondingly difficult, which is why a specialist is often needed: Ask your doctor if pain cannot be relieved promptly.
  • Effective pain relief often requires strong drugs, such as opiates. It is important to use the correct dose and take it in good time so that you can permanently relieve the pain.
    If strong pain killers are discontinued, this must be done step by step in consultation with the doctor. Then there are no withdrawal symptoms.
  • In pain therapy, it is important that the medication is taken or used exactly as directed. Several medications often complement each other, e.g. a long-term medication (basic therapy), an additional pain reliever (co-analgesic) and an emergency medication that works within minutes if peaks of pain break through the basic therapy. Patients and relatives should only deviate from the medical guidelines after consultation.

If common pain relievers do not help enough, the use of drugs made from cannabis can be considered. Cannabinoids are increasingly used in palliative care and since March 2017 can be prescribed by a doctor under certain conditions. For more information, see Medical Cannabis.

In addition to medication, there are also many nursing and social measures that can alleviate pain, depending on the cause of the pain. For example, if pain is spasmodic, relaxation and warmth can help. For inflammatory pain, cooling may be the right thing to do. Distraction can "make you forget" pain.

14. Nausea and vomiting

Nausea and vomiting plague many patients, and they can also occur independently of one another. The causes are complex and the development is complex - relief can be correspondingly difficult.

However, because nausea, gagging and vomiting severely limit the quality of life, alleviation must be sought. It starts with creating a pleasant, fresh room atmosphere, continues through nursing measures and medical treatments to the administration of medication. The social and psychological level should not be overlooked either: fear or disgust can "hit the stomach". The guiding principle is always the patient's feeling: Everything should be avoided or removed if possible that causes him or her to feel uncomfortable.

In any case, speak to the attending physician, as there are a wide variety of medications that can relieve nausea and vomiting.

15. Restlessness (agitation)

Strong restlessness is shown, for example, by patients who can no longer orientate themselves clearly or who can no longer be addressed. The diagnosis of "restlessness" is therefore often based on behavior, e.g. when the patient is rolling in bed, constantly fiddling with something, moaning or calling for help. This is particularly difficult to bear for relatives or neighbors.

Finding out the causes is difficult because the patients can often no longer express themselves clearly. If no organic cause can be found (e.g. pain), devotion and time often help: being there, holding hands, speaking, narrating, reading aloud. Calming and relaxing care measures can also alleviate - it is helpful if you know what the person likes. Sometimes, however, it is "just" a matter of enduring the condition with the patient, not causing any further activity and not building up any pressure. If relatives lack the composure to do this, which is very understandable, they should not be afraid to seek advice and support from hospice services and palliative care professionals.

If nothing else works, medication can be used to relieve anxiety.

16. Constipation (constipation)

Constipation affects over half of all palliative care patients and is often difficult to resolve because there can be many causes that work together. The most common causes are:

  • Taking opioids - but usually light laxatives (laxatives) are also prescribed with these medications
  • Certain diseases, e.g. cancer, and their consequences
  • Sedentary lifestyle
  • Insufficient fluid and / or food intake
  • Lack of fiber
  • Metabolic disorders

Since bowel movements are very intimate, psychological and social factors can also play a role. With this in mind, the therapy must also be approached sensitively. There are many therapeutic options that can help promote bowel movements:

  • Change diet (at the end of life often not possible or useful)
  • Drink more (at the end of life often not possible or useful)
  • Promote bowel activity through exercise or massage
  • Oral medication
  • Suppositories
  • enema
  • Manual evacuation (last resort and only to be carried out by experienced nurses)

The therapy must always take into account how strong the patient is, whether the measures cause pain and whether there are interactions with other therapies and drugs.

Towards the end of life, when a patient no longer wants to eat or drink, it can sometimes be appropriate to accept the constipation. Then you shouldn't spend the very last part of your life with burdensome laxative measures. However, this should only be done in the last few days, because otherwise it can lead to a painful and dangerous intestinal obstruction (ileus), which may have to be treated or operated in hospital.

17. Related links

Palliative care guide

Palliative phase

Palliative care

Palliative care

Palliative care by relatives

Fatigue - Chronic Fatigue Syndrome

Medical cannabis