The information provided in this section is a guide to other symptoms which you may be trained to give as-needed medication for. It aims to provide information about what to expect, simple suggestions that can ease the symptoms and outlines subcutaneous medications that can assist with management. For information about other symptoms consult your healthcare team.
Agitation or restlessness is common, particularly in the last days or hours of life. The person may seem anxious or unsettled, have fidgety movements, make distressed sounds, or have twitching. The person may pick at the bedclothes, or they may moan or call out, or make a noise each time they breathe. This can be distressing for carers to see.
Check to see if the person is experiencing any pain, or anything obvious that may be causing the problem.
You may be able to help reduce the restlessness by simply sitting with the person and reassuring them that they are safe and loved. The healthcare team will be able to help work out whether pain is causing restlessness, and if so, how to treat it. Refer to Table 2 for commonly used subcutaneous medications that your healthcare team may have prescribed.
Anxiety can also make someone look restless. The causes of anxiety may be physical, emotional or a combination of both. If a person becomes anxious it can increase other symptoms such as pain, nausea/vomiting or breathlessness. It is important to recognise if the person you are caring for becomes anxious, so that you can relieve this with the medication that has been prescribed by the healthcare team. Table 2 outlines some of the common subcutaneous medications used for anxiety.
There are many reasons why someone can feel nauseous (sickly) or vomits, including side effects of strong pain medications. Nausea may be experienced with or without vomiting. It may help if the person rests for about one hour after taking strong pain medications.
Nausea and/or vomiting can be treated with medications, given either in a syringe driver or pump or given as breakthrough medication via the cannula or a combination of both. There are several medications that assist with nausea and vomiting – Refer to Table 2 for commonly used subcutaneous medications that your healthcare team may have prescribed.
Towards the end of life a person’s breathing may become noisy. This is likely to be because of some fluid collecting at the back of their throat as they are too weak to swallow, which can cause a rattling sound. Noisy breathing does not seem to cause distress to the dying person, but may be upsetting to hear. It may be helpful to change the person’s position so that they are lying more onto their side with their head slightly raised. There are medications which may help to reduce noisy breathing. Refer to Table 2 for commonly used subcutaneous medications that your healthcare team may have prescribed.
Some people may experience difficulty with breathing. This may be related to their disease, to anxiety or a combination of both. If this is a new symptom please report it to the healthcare team. Often, shortness of breath can contribute to anxiety.
Some strategies that can help a person with breathing difficulties include:
Opioids such as morphine is used for the relief of the sensation of breathlessness. Midazolam is used for the anxiety associated with breathlessness.
Itchiness is common towards the end of life and can be caused by many things such as dry skin, allergy, side effects of medications or the disease itself. If left untreated it may cause the person to become restless or anxious. Applying skin creams that are water-based, especially after a bath will help.
|Name of drug||What is it used for?||How long does it take to work after subcutaneous injection?||Common side effects|
|Glycopyrronium||15-20 minutes; peaks within 45 minutes.|
|Hyoscine Hydrobromide||30 minutes to take full effect and lasts about 4 hours|
|Levomepromazine (Nozinan)||60 minutes to take full effect|
|Midazolam||10-15 minutes, short acting.|
|Cyclizine||60 minutes to take full effect|
Check instructions left for you by the healthcare team. They will explain to you how often the medication can be given.