Anticipatory prescribing is the prescribing and provision of medicines ahead of time to people whose death is expected. It is recognised as effective practice for patients receiving palliative and end of life care. The main aim of anticipatory prescribing is to ensure medicines are readily available to manage the symptoms that commonly occur at the end of life - such as pain, agitation, breathlessness, nausea and vomiting, and excess respiratory secretions. It also aims to prevent unwanted hospital admission if the patient's chosen place of death is at home. This article explores the evidence and guidance to support anticipatory prescribing, alongside the benefits and challenges associated with this practice.
Shock is a potentially life-threatening condition characterised by impaired perfusion of tissues and organs and inadequate cellular oxygenation. If left untreated, shock can lead to organ dysfunction, organ failure and death. This article explores the pathophysiology of shock and its underlying causes, including key physiological concepts such as blood pressure, cardiac output, preload, contractility and afterload. It examines the different types of shock and their relationship to these physiological concepts, alongside strategies for assessment and management. The authors also discuss the crucial role of nurses in assessing and managing patients with shock as part of the multidisciplinary team.
Inappropriate sexual behaviour (ISB) is a recognised but underdiscussed aspect of the behavioural and psychological symptoms of dementia (BPSD), and may arise from neurocognitive changes, unmet emotional or relational needs and/or environmental stressors. ISB can have significant negative effects on the individual, their family caregivers, healthcare professionals and other formal carers, and presents management challenges. Nurses have a central role in assessing and managing ISB, therefore it is essential that they understand the underlying causes of such behaviours and are able to respond compassionately and professionally. This article provides an overview of ISB, including the potential underlying causes and effects of the behaviours, and describes the elements of a comprehensive assessment and some evidence-based management strategies. The author also considers some of the ethical, legal and safeguarding aspects of sexual expression in individuals with dementia, including those displaying ISB. Adopting a person-centred approach to the assessment and management of ISB can support nurses to protect both the individual's dignity and the safety of others.
