Table 1 Patient instructions for family caregiver

Phase 1. For restless and anxious individuals with respiration rate less than 20 times per min, follow the steps below:

 1. Check if he or she is feeling unwell.

 2. Use a fan or open the window to improve air circulation [22].

 3. Massage the acupuncture points Lu 10 (Yuji), Lu 7 (Lieque) and ST36 (Zu San Li) or have him or her try to meditate [23, 24].

 4. Refrain from straining when urinating or defecating.

Phase 2. For individuals with respiration rate between 20 and 24 times per min, follow the steps below:

 1. Check vital signs.

 2. Check if he or she has been taking medications as prescribed.

 3. In case of thick sputum, use an ultrasonic nebulizer for steam inhalation.

 4. If necessary, clear sputum with sputum suction therapy.

 5. Breathe air in from the nose and breathe out from the mouth with a pursed lip.

 6. Prepare to rent a medical oxygen generator in case oxygen therapy is needed.

 7. Stay with the patient.

 8. Sit in a reclined position or lie down with head elevated with cushioning at a 30–45 degrees angle.

 9. Take extra precaution to protect the oral mucosa for mouth breathers.

Phase 3. For individuals with respiration rate more than 24–28 times per min or with sighing respiration (deep breaths), follow the steps below:

 1. Check vital signs.

 2. Check consciousness.

 3. Check for death rattles.

 4. Provide oxygen therapy.

 5. Consider giving medication for management of shortness of breath.

 6. Call the palliative home-care nurse.