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Flashcards in Respiratory Secretions at End of Life Deck (28)
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1

What does the current best practice for the management of respiratory secretions at EoL involve?

Combination of nursing and pharmacological management

2

What do respiratory secretions at the end of life cause?

Noise produced by air moving through secretions in the upper airways, often referred to as 'death rattle'

3

What causes the production of respiratory secretions at the end of life?

The mechanism by which secretions are produced is not well understood, but they are thought to arise from the salivary gland and bronchial mucosa

4

Why does saliva accumulate at the end of life?

Thought to be related to a decline in consciousness and swelling

5

Why does secretions from the bronchial airways accumulate at the end of life?

Weakness or reduced consciousness meaning the patient is unable to cough effectively

6

How long does the accumulation of bronchial secretions take at end of life?

Thought to accumulate over several days as the patient deteriorates

7

What is the prevalence of respiratory secretions at the end of life?

Considered a common occurrence, but reported prevalence varies from 12-92%

8

What is the impact of respiratory secretions at the end of life?

There is little evidence to suggest the unconscious patients are distressed by the presence of respiratory tract secretions, but some families find it distressing and are concerned it is contributing to the patients suffering

9

What is involved in the management of respiratory secretions at the end of life?

- Reposition patient to move secretions within the airway
- Explore any family concerns, providing reassurance and explanations as necessary
- Reduce or discontinue artificial hydration
- Regular oral care
- Administration of anti-muscarinic medications

10

What is the role of deep suctioning in the management of respiratory secretions at the end of life?

Should be avoided

11

Why should deep suctioning be avoided?

Because it is likely to cause distress to the patient, and may increase the production of secretions

12

What should the drug choice in managing respiratory secretions be based on?

Clinical requirements and drug characteristics

13

How should drugs to manage respiratory secretions be given?

Efficacy should be assessed using PRN dosing, before moving on to a continuous infusion

14

How can the risk of unwanted side effects be minimised when using drugs to manage respiratory secretions?

Medication that is shown to be ineffective should be discontinued

15

What are the options for medication to manage respiratory secretions at the end of life?

- Hyoscine butylbromide
- Hyoscine hydrobromide
- Glycopyrronium

16

How are medications to manage respiratory secretions administered?

SC

17

Is hyoscine butylbromide sedating?

No

18

Is the onset of action of hyoscine butylbromide fast or slow?

Slow

19

Does hyoscine butylbromide cross the blood-brain barrier?

No

20

What is the onset of action of hyoscine hydrobromide?

30 minutes

21

What is the duration of action of hyoscine hydrobromide?

4-6 hours

22

Can hyoscine hydrobromide cross the blood-brain barrier?

Yes

23

What is the result of hyoscine hydrobromide being able to cross the blood-brain barrier?

May cause side effects such as confusion, sedition, or paradoxical excitation

24

Is glycopyrronium sedating?

Moderately

25

What is the onset of action of glycopyrronium?

1 hour

26

What is the duration of action of glycopyrronium?

4-6 hours

27

Why does evaluation of the efficacy of interventions for respiratory secretions need to be made frequently?

To ensure symptoms are well-controlled and patient comfort is maintained

28

What is important regarding the family in the management of respiratory secretions at the end of life?

Sensitive exploring of concerns and explanations regarding nursing care and medical interventions with the family