Helping a patient achieve comfort at end of life is not that easy....

[MomRN0913]

The hospice patients I have usually get kicked off of hospice before getting to the end stages. And now I'm getting more hospice ( finally). And they are dying.

Helping a patient acheive a comfortable death is a real challenge! I'm finding in our hospice, the nurses pretty much run the care..... Tell the docs why to order and they say "ok". It's almost like being a doctor!

My patients a re having kind of " drawn out" deaths, and trying to keep them comfortable ( respiratory and anxiety wise is harder than pain wise.

Any tips would be appreciated. I wish my patients would just slip away in their sleep.....

[lovinlife11]

I think all hospices are run that way. We are the physicians eyes and ears and already know what we want to try when we get orders. Are u using morphine/Ativan combo? Are there learning barriers with the caregivers where they are not able to administer meds? Elevating the head of the bed? Cool fan on the face?

[Daisy_08, BSN, RN]

Sounds like where I work too.

Making sure they have round the clock pain management, that also helps with the breathing. A little nozinan or versed is always nice to keep them calm.

I think we should use palliative sedation more then we do. It is dependent on the doc. But if that were me, bring on the katamine!

[lpoore]

Hi! That is the same with the hospice I work for. Have you tried something like ABH scheduled ATC? Every pt is different and it is usually a trial and error finding the right med/meds that work for the pt.

Good Luck

[tewdles, RN]

Your respiratory patients will require a level of polypharmacy that many patients do not to achieve optimal symptom relief. Many of them have referred pain as well as dyspnea.

opiates, benzos, expectorants, sleep aids, bowel regime are all critical to the comfort of persons suffering from E/S pulmonary disease.

Hypercapnia in the last days/hours is a blessing...