A terminally ill patient has become confused, disoriented, and restless. The patient is incoherent and has had constipation for 3 days. What action should the nurse take next?

A terminally ill patient has become confused, disoriented, and restless. The patient is incoherent and has had constipation for 3 days. What action should the nurse take next?

• A. Obtain a prescription for a benzodiazepine.
• B. Administer laxatives to treat constipation.
• C. Do not take any measures as this is normal during the terminal stage.
• D. Inform the family members that the patient is breathing the last breaths.

Answer: (B)

The main idea here is that treating reversible physical causes can relieve distress in a dying patient. Constipation is very common in terminal illness, often due to opioid use and reduced GI motility, and it can drive confusion, restlessness, and incoherence. When the patient is uncomfortable and delirious, addressing the stool burden directly targets a likely source of agitation and improves comfort and mental clarity. Starting a bowel regimen with laxatives to relieve the constipation is therefore the best next step, because it treats the root cause of several distressing symptoms rather than just sedating the patient or delaying action. Benzodiazepines might help with agitation in some contexts, but they don’t relieve constipation and can worsen delirium or respiratory depression, so they’re not the preferred first move here. It’s also not appropriate to assume no measures are needed in the terminal phase, since relieving a treatable symptom like constipation aligns with comfort-focused care. And while honest communication with family is essential, stating that the patient is in their last breaths is not an immediate clinical step based on the information provided.

The main idea here is that treating reversible physical causes can relieve distress in a dying patient. Constipation is very common in terminal illness, often due to opioid use and reduced GI motility, and it can drive confusion, restlessness, and incoherence. When the patient is uncomfortable and delirious, addressing the stool burden directly targets a likely source of agitation and improves comfort and mental clarity. Starting a bowel regimen with laxatives to relieve the constipation is therefore the best next step, because it treats the root cause of several distressing symptoms rather than just sedating the patient or delaying action.

Benzodiazepines might help with agitation in some contexts, but they don’t relieve constipation and can worsen delirium or respiratory depression, so they’re not the preferred first move here. It’s also not appropriate to assume no measures are needed in the terminal phase, since relieving a treatable symptom like constipation aligns with comfort-focused care. And while honest communication with family is essential, stating that the patient is in their last breaths is not an immediate clinical step based on the information provided.