Comfort Measures ONLY

[Katie5]

What exactly constitutes this?And since you need a physician's order for oxygen, should this be considered a "within nurses' discretion for comfort measures. And why not just the physician or hospital write what the comfort measures should consist of or not.

[morte, LPN, LVN]

i would think this is were the MSO4 would come in....

[tewdles, RN]

Interesting question - what about when a particular comfort measure is also causing discomfort?

For example: pt with end stage respiratory failure/COPD elects not to be intubated/ventilated and has used CPAP in the past to control work of breathing, CO2 retention etc. CPAP is now implemented to relieve shortness of breath, excess work of breathing etc and allow the patient to spend her remaining time with family (without the CPAP she would deteriorate much faster.) However, the CPAP is causing incredible discomfort - feelings of suffocation, drowning and so forth.

What would the nurse be able to do here?

In hospice I would medicate the patient and remove the CPAP...pt comfort is priority, rate of deterioration is not so much.

That philosophy is hard (sometimes) for those outside of the hospice framework. Patients are allowed to make their own choices about comfort, even when those choices may allow a more rapid deterioration.

Think of your scenario this way...if the lady with COPD is feeling like she is suffocating, drowning, and so forth what value, dignity and comfort is there for her in "spending her remaining time with family"? If the patient does not want the intervention she does not have to have it...not in my care.

[blondy2061h, MSN, RN]

We have a comfort care order set. Things like lasix drips and oxygen are not usually used on our comfort care patients. Our typical orders are a narcotic drip, IV ativan as needed for anxiety, antiemetics, atropine SL drops to control secretions, scopolamine patches, skin creams, lip ointments, mouth swabs, and eye drops. We usually do vitals only once a day on these patients.

[Bill E. Rubin]

Please make sure you refer to "diapers" as briefs when working in the clincial setting (unless you are dealing with young children). It is a degrading and negative term when referring to the elderly, especially those toward the end of their lives. It does nothing to help preserve their dignity.

this is a big pet peeve of mine; and I'm sorry if my post offended you in any way.

Best,

Diane, RN

The only thing I find offensive about this is the assumptipon that I use the same terminology when talking to the patients as I use with fellow nurses.

I do, actually, use the term "brief" or "briefs" when discussing with pts or families... Though I have been corrected on more than one occasion by an exasperated pt telling me to "just call them diapers."

[tewdles, RN]

We have a comfort care order set. Things like lasix drips and oxygen are not usually used on our comfort care patients. Our typical orders are a narcotic drip, IV ativan as needed for anxiety, antiemetics, atropine SL drops to control secretions, scopolamine patches, skin creams, lip ointments, mouth swabs, and eye drops. We usually do vitals only once a day on these patients.

why do you comfort orders not include oxygen?

must the person have an IV?

[heron, ASN, RN]

Interesting question - what about when a particular comfort measure is also causing discomfort?

For example: pt with end stage respiratory failure/COPD elects not to be intubated/ventilated and has used CPAP in the past to control work of breathing, CO2 retention etc. CPAP is now implemented to relieve shortness of breath, excess work of breathing etc and allow the patient to spend her remaining time with family (without the CPAP she would deteriorate much faster.) However, the CPAP is causing incredible discomfort - feelings of suffocation, drowning and so forth.

What would the nurse be able to do here?

First ask the patient what s/he wants.

Then, lots and lots of morphine and ativan.

[leslie :-D]

Then, lots and lots of morphine and ativan.

yes indeed...

lots of it.

liken it to a terminal wean.

there is no other way to deal with this.

leslie

[DLS_PMHNP, MSN, RN, NP]

The only thing I find offensive about this is the assumptipon that I use the same terminology when talking to the patients as I use with fellow nurses.

My apologies to you. I did not mean to offend or insinuate that in any way.

Best,

Diane

[rngolfer53]

Just a funny side note. I agree with Diane in regards to referring diapers as briefs. I have done that and then the pt will look at me confused and ask, "you mean the diaper?". This has happened many times and I end up using whatever term the pt uses so as not to confuse my already confused pt's. :)

Or, when I'm in a Pt home, I'll ask the family if they have "briefs" for the now-incontinent Pt. They'll sometimes hand me Fruit of the Loom.

Not what I had in mind. I'm waiting for the first time a family says, "no, he wears boxers.":D Sometimes plain language is best.