C.A.R.E.S.: A Tool for the Care of the Dying

Bonnie Freeman, RN, DNP, ANP, ACHPN, Compassionate Person-Centered Care for the Dying

Restlessness

The restlessness that commonly occurs during the dying process is also called terminal or agitated delirium. It can also result from pain, bladder distention or stool impaction.

  • The patient must be protected from injury and the family needs to be supported.
  • Consider the following:
    • Give a trial dose of opioids to rule out pain.
    • Assess for bladder distention and insert indwelling catheter if needed.
    • Assess for impaction if appropriate.
    • Consider antipsychotics: haloperidol or chlorpromazine.
    • Consider benzodiazepines: lorazepam or midazolam.
    • Maintain calm environment.
    • Minimize bright lights.
    • Play patient’s favorite music.
    • Talk softly to patient; maintain use of touch and presence.
    • Comfort patient by saying: “You are safe. We are with you. We love you.”
    • Consider aromatherapy.
    • Unfinished business may cause restlessness discuss with family possible causes of anxiety.
    • Review with the family the importance of saying good-bye and to give permission to stop fighting.
    • Question family about an important family event or anniversary.
  • Educate the family:
    • Patient lacks awareness of behavior.
    • Possible to be peacefully confused.