Hospice comfort

Jensmom7, BSN, RN · Sep 1, 2015

Is this an answer to a homework question? Are you looking for validation for your answer, or do you feel you need to expand upon it?

OrganizedChaos, LVN · Sep 1, 2015

Created account today & only this one post. I smell homework.

Jensmom7, BSN, RN · Sep 1, 2015

Me also, and frankly not a very good answer. She needs to read some more.

Tenebrae, BSN, RN · Sep 1, 2015

Comfort cares are about keeping the patient comfortable

What that may entail will vary from patient to patient to patient including the use of low flow oxygen, syringe drivers and others

Trauma Columnist · Sep 1, 2015

Moved to Nursing Student Assistance forum.

Jenngirl34RN · Sep 4, 2015

Comfort is to allow a natural death without tubes (IV or nasal cannula) and monitors as they increase family anxiety. "

Comfort care has a lot more to do with the patient than your answer would suggest, and IVs and nasal cannulas are used, as patients often need IV pain medications and fluids, and patients aren't denied oxygen if needed. Family anxiety is often addressed, but "tubes" are not avoided because of that if the patient needs them to be comfortable. Family members can be more anxious if their loved one is in pain or distressed.

I suggest you do some more research on what exactly comfort care is.

KelRN215, BSN, RN · Sep 4, 2015

Comfort is to allow a natural death without tubes (IV or nasal cannula) and monitors as they increase family anxiety. We can expect abnormal readings and labs. Ultimately about everyone dies of a multi system organ failure. The lungs are not operating efficiently and no amount of oxygen will stop the process and in fact may prolong death. Medications on the other hand are most comforting and effective to manage air hunger in COPD or heart disease only. It is normal to see an agonal breathing pattern at end of life that should not be confused with "gasping for air."

False. Comfort care can, and often does, involve IVs or oxygen therapy. Oxygen isn't going to prolong anything, when the patient stops breathing it doesn't matter how much oxygen is being pumped into their lungs, no gas exchange is happening. Every comfort care patient I've ever cared for had an IV and was on continuous morphine or dilaudid as well as versed or ketamine.

While we often try to convince families to turn off monitors, sometimes they'd rather see it. It's not like we say "you cannot keep your child on the monitor." For families who wanted it, we'd turn the alarms off so it wasn't beeping constantly when anything happened.

Here.I.Stand, BSN, RN · Sep 7, 2015

Comfort is to allow a natural death without tubes (IV or nasal cannula) and monitors as they increase family anxiety. We can expect abnormal readings and labs. Ultimately about everyone dies of a multi system organ failure. The lungs are not operating efficiently and no amount of oxygen will stop the process and in fact may prolong death. Medications on the other hand are most comforting and effective to manage air hunger in COPD or heart disease only. It is normal to see an agonal breathing pattern at end of life that should not be confused with "gasping for air."

You've gotten some answers from at least one practicing hospice RN, and others who have been involved in end-of-life care. As an ICU nurse, I am the latter type; we frequently go straight from critical care straight to comfort care. I am going to address some points, even thought the others have done so already. I just can't help myself. I'll address the bolded points in order.

1.) Comfort care is patient-centered first, then family-centered. If supplemental O2 appears to increase pt comfort, we use it. It may well do nothing for the pt, but for some families, they may feel comforted by the sight of their loved one receiving O2. If a family expresses the desire to have a little O2 on Grandma, an RN would never tell them, "No, tubes increase family anxiety."

1a.) Of course IVs are used. How else do we give IV morphine or Ativan?

2.) We can't expect abnormal labs because we don't draw labs in comfort care pts. What we can expect is for all labs, tests, VS, and medications to be d/c'ed, except for ones that provide comfort (e.g. morphine, ativan, meds to decrease secretions.)

3.) Nasal cannula O2 doesn't prolong the dying process. Intubation would. Nasal cannula O2, again, is used in certain circumstances.

4.) Meds are used to manage air hunger in any pt that is showing signs of air hunger. No palliative care MD is going to say "well I know your loved one is dying of a TBI, but I'm not going to Rx any meds for their air hunger. That's only for heart disease and COPD."

5.) Agonal breathing patterns don't look like gasping for air. If the pt looks like she/he is gasping for air, the symptom of air hunger is treated.

KelRN215, BSN, RN · Sep 18, 2015

I thought about this thread the other day when thinking of my grandfather. When he was dying, I wanted to keep the monitor on because I wanted to anticipate what was happening. And, had it been off, my mother, aunt and uncle would have slept through his death. That wouldn't have been comforting to any of us. I'd stayed awake all night but they'd fallen asleep. The vtach alarm woke them up just in time to say good-bye at his final moments. Comfort care is unique to the family and patient. It can involve monitors. And it most certainly involves IVs and oxygen at times. My grandfather was on oxygen at the end as well, come to think of it.

KelRN215, BSN, RN · Sep 22, 2015

Medications on the other hand are most comforting and effective to manage air hunger in COPD or heart disease only.

Care to tell that to the parents of an air hungry dying 15 year old with Ewing's Sarcoma?

You should really take everything you've learned in this thread under advisement. Your assumptions/generalizations about comfort care at the end of life are wrong.

Sun0408, ASN, RN · Sep 22, 2015

I've seen my fair share of pts die on the vent. My last pt lasted less than 30 minutes after shutting off the gtts only. The vent did not prolong the death by much if at all but it was a comfort to the family not to see agonal breathing. Of course the monitors were still on and I was able to be at the bedside before the heart stopped beating to be with the family. They also could see the event unfold and be prepared for what was coming based on heart rate. Point is, every pt, every death and every situation is different and we have to be flexible!!!