A client in the last days of life has a dry mouth and new noisy respiratory secretions. The client is relaxed, has no grimacing or labored breathing, and the family says, “It sounds like suffocation.” Complete the nurse’s clinical interpretation and plan.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Noisy terminal secretions are often more distressing to family than to the dying person. The nurse assesses the likely cause and the client’s comfort, explains that the sound is unlikely to mean suffocation, provides frequent mouth and lip care, and considers repositioning. Medication is considered as an individualized trial when secretions cause distress, with reassessment for benefit and adverse effects such as dry mouth, delirium, agitation, or sedation.
Correct Answer The current finding is noisy terminal secretion without observed client distress; explain and provide mouth care with repositioning; reserve a monitored antisecretory trial for distress that persists despite comfort measures.
Why It Fits The scenario separates the family’s fear from the client’s observed comfort and requires the nurse to match intervention intensity to the person’s symptoms and goals.
Clinical Picture Dry mouth needs direct care. Repositioning and explanation can reduce burden without assuming the sound represents suffocation. Medication may worsen dryness or cognition and is not automatically required for sound alone.
Memory Link Treat the person’s distress, not the room’s distress.
NCLEX Rule Assess cause and comfort first, use individualized nonpharmacological care, and monitor any medication trial for effect and adverse effects.
Why the Alternatives Fail Routine deep suction can cause discomfort; automatic hydration or medication ignores individualized goals; withholding mouth care fails to treat an existing symptom.
Sources
1NICE: Care of Dying Adults Recommendations
22026 NCLEX-RN Test Plan
The goals are comfort and shared decision-making. The nurse distinguishes distress in the client from distress caused by the sound, addresses reversible discomfort, and avoids escalating treatment solely to make breathing quieter.
Noisy respiratory secretions — Saliva or mucus that accumulates when a dying person can no longer clear it; the sound may distress family even when the person appears comfortable.
Antisecretory medicine — A medication trial used selectively for distressing terminal secretions and monitored for benefit and anticholinergic adverse effects.