This is more complicated by the prevalence of other mental disorders like dementia and drug induced mood swings. Nurses need to be well trained in pattern recognition and logical assessment of the condition and take suitable action to solve these problems. [Steve Lliffe, 107]

The failure to manage these symptoms would result in increased suffering and poor quality of life in the end stage. In a 1993 study conducted on 295 patients admitted for palliative care it was found that 99% of the patients had asthenia (fatigue) while more than 76% reported pain. Another study by Coyle et al. In 1990 revealed that in 75% of patients in palliative care there is usually a combination of symptoms. (Fatigue, pain, anorexia) etc. [Kim Kubler] Asides DNR, there are other morally distressing issues for the nurses to handle. For example, food intake would stop during the final hours of the patient as...
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