What do we do tonight if they become breathless, agitated or in pain?

Australia · 29 August 2026 · 4 min read · Reviewed by Dr Kane Treble

Use the person's written palliative care plan first.

Use the person's written palliative care plan first. It should tell you what to do for breathlessness, agitation or pain, which medicines can be given, and who to call after hours.

If there is no plan, the plan is unclear, or the symptom is severe, call the palliative care team, after-hours nurse, GP, healthdirect or local urgent advice service. Call 000 if there is a life-threatening emergency.

General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.

Before night starts

If possible, prepare before everyone is exhausted. Put the care plan, medicine chart, phone numbers and medicines in one safe place. Check that you know where the torch, thermometer, continence supplies, spare linen and syringe driver instructions are.

If anticipatory or breakthrough medicines have been prescribed, check that you know which symptom each medicine is for. Do not wait until 2 am to find out that a medicine label is unclear.

If they become breathless

Stay with them. Sit them upright or turn them to a position that eases breathing, if safe. Open a window or use a fan if that helps. Speak slowly and reduce crowding around the bed.

Use the written plan for breathlessness. This may include a breakthrough medicine, oxygen if it has been prescribed, or a call to the palliative care team. Do not start oxygen or give extra medicine unless it is in the plan or a clinician tells you to.

Call urgently if breathlessness is sudden, severe, blue lips appear, the person is panicking and not settling, or this is different from what the team prepared you for.

If they become agitated

Agitation can have many causes. Pain, breathlessness, a full bladder, constipation, delirium, medicine effects, fever, fear and the dying process can all contribute.

Reduce noise and light. Speak calmly. Check whether they need to pass urine, are too hot or cold, or are uncomfortable in the bed. If the plan includes medicine for agitation, use it exactly as written and record the dose.

Call the team if the person may fall, pull out lines, hit out, seems terrified, or does not settle after the plan is followed.

If they are in pain

If the person can speak, ask where the pain is and how bad it is. If they cannot speak, look for grimacing, moaning, guarding, restlessness, tense muscles or distress during turning.

Give breakthrough pain medicine only if it is prescribed for that symptom and enough time has passed since the last dose. Record the dose and effect. Call if pain remains severe, returns quickly, or you need repeated doses.

If symptoms happen together

Breathlessness, agitation and pain can feed into each other. A person in pain may become restless. A breathless person may panic. A confused person may not be able to explain pain.

This is a good reason to call early. The team may help you decide which symptom is most likely and what to do first.

When to get help now

Call the palliative care team or after-hours service if any symptom is new, severe, worsening, or not settling with the plan.

Call 000 if the person is not breathing, cannot be woken, has severe uncontrolled bleeding, is choking, has a serious injury, or you think there has been a dangerous medicine error.