Hospice Care Question

[tri-rn]

Hi to all,

I work in an ICU, but frequently our patients make the transition from being "ICU" to "hospice" and remain with us for a time....often for all of thier remaining time. We have a palliative care team (teaching hospital) and use them when they're available. Sometimes, unfortunately, they can't come right when we need them.

Is it ever acceptable to use O2 (by nasal cannula, 2L) on a dying patient as a comfort measure - not to bring up O2 sats, but to help them deal with feelings of air hunger? It seems to me like that would be a horrible, scary feeling.

I'm aware that morphine also helps, but I had a pt a while back who appeared to be uncomfortable and upping her morphine gtt didn't seem to help.

Thanks!

[leslie :-D]

yes, o2 (via nc) is fine.

i can't say anything about the morphine not working, w/o further info.

like, how much is she getting?

and is she in pain

i can guide you further once i know where pain is, and what she's been getting.

also, ativan (or another benzo) for anxiety.

should have that bid at a minimum.

i don't know how close she is to death, but keep in mind that being on narcs, WILL constipate your pt...

and notably increases the burden of suffering.

so have doc add to these orders accordingly.

please don't hesitate to ask any sort of questions here.

we would all love knowing she passed peacefully.

leslie

[tri-rn]

Thank you for the response Leslie! And yes, he passed peacefully that same day. I wish I could remember exactly what it was that made me think he was feeling some air hunger. Maybe it will come to me in the night. But I do remember thinking a couple of liters O2 might make him more comfortable, and another RN stopping me. But whatever it was, didn't seem like pain. I do recall increasing his morphine gtt. I'm sorry, I wish I could remember it more specifically. This happened some time ago, but another hospice post brought it to my my mind.

[melsch]

Dyspnea is such a common symptom in our dying patients. In our inpatient hospice we can't put O2 on without a dr order, but we find turning on a fan works just as well. I have been told it isn't the oxygen that makes them feel better as much as just having air movement in the room. We also use morphine or dilaudid for their effect on the patient's breathing, and Ativan and nozinan for the anxiety that comes with being unable to get your breath. It seems that most of our patients are pretty comfortable, most of the time, so by my observations it usually works.