what is comfort care only?

[Ms.RN]

hello

i'm confused about advanced directive. what does it mean to you when the advanced directive states "comfort care only?" does it mean patient can be medically treated? does it also mean patient can have iv fluid?

[JAHJF]

Yes, pt can be medically treated.

Our comfort cares are usually terminally ill and have DNRs; we provided hydration (PO/IV), pain medication, O2 therapy, medications that pt can tolerate taking (PO/PR/IV). In other words, do what you can to make them comfortable until they pass (no CPR/defibrillation/intubation/code meds).

[Nascar nurse, ASN, RN]

In our facility, we usually let the resident (if able to) or the family decide about IV fluids/meds, etc. We give them the options and let them decide. Each has there own ideas of what "comfort" means to them and we kind of go with the flow on that. No heroic measures tho - CPR, defib, etc

[Jo Dirt]

When a patient is on comfort measures only, that means it has been determined they are past the point of restoring their health and will die within short time.

I don't believe they generally give IV fluids or anything much other than pain meds to someone on comfort measures.

[JAHJF]

Sorry, just realized that this is LTC forum; I work Cardiac step-down and rarely have comfort measure pt's but I did mean to imply that we have those options available to the pt but we never force the pt to do something they don't won't too. :)

[lovingtheunloved, ASN, RN]

Gee, where I work, it means the aides leave the person in bed and more or less ignore them for the remainder of the shift, until the overpowering smell of urine wafts out into the hallway. Sounds comfy, don't it?:angryfire

[pricklypear]

Sorry, just realized that this is LTC forum; I work Cardiac step-down and rarely have comfort measure pt's but I did mean to imply that we have those options available to the pt but we never force the pt to do something they don't won't too. :)

I think it is a bit different in the hospital than hospice or LTC. I work in a hospital, and it varies from patient to patient. Some we continue to care for as usual, with liberal pain medication, continue TF, IV, vitals. Some we just disconnect from everything, no vitals or anything except repositioning, oral care and pain meds.

[stidget99]

-pt's sugar is 25

-pt's fever is 104.2

-O2 sat 79% on room air

-pt is in pain

Calling the doc and addressing any of these issues and the doc decides to NOT treat because "they are DNR anyways"

Now that really *^% me off!!!!

DNR does NOT mean "do not treat"!!!

[doodlemom]

I work in hospice but when I used to work in the hospital I used to cringe when the docs would put people on comfort measures only and then keep them on IVF. When a patient is dying, the most uncomfortable thing you can do for them is give them IVF. It generally causes the pt to drown from all of the fluid that goes into their lungs. That seems like the worst thing imaginable to me.

[espikey]

In reading this thread, I'm a bit confused- what is the difference between comfort care and hospice?

espikey

[Daytonite, BSN, RN]

in reading this thread, i'm a bit confused- what is the difference between comfort care and hospice?

espikey

not much really. the new term being tossed around these days is end of life care. here are some links to information about it:

• http://www.thehospice.org/dyingprocess.htm
  
• http://www.aacn.nche.edu/index.htm
  
• http://www.aacn.nche.edu/elnec/resources.htm
  
• http://www.stvincent.org/ourservices/hospice/preparing/default.htm
  
• http://www.mywhatever.com/cifwriter/library/eperc/fastfact/ff_index.html

[nightmare, RN]

We call it TLC, Tender Loving Care, generally it is pain relief ,oral care ,skin and pressure care etc .I agree with previous poster IV or sub cut.fluids just prolong the process.