Hospice @ LTC ??

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Specializes in Geriatrics, Pediatrics, Home Health.

Hi,

I have a question about my responsiility. One of my pts is under hospice care. They have a CNA sitting with him 24/7 and she gets his vitals. Early this AM she came to me and informed me that he was restless and had some apnea. I went in a checked him and gave him 0.25ml of ativan SL. He never calmed down and his temp spiked to 104 AX.

My questions are:

When hospice moves in, where/what do I do? I was off for a week and came back to this.

I asked what I could do and NO ONE seemed to know!! All he has now is IVF and a pain pump.

Back to the comfort mearsures only crap. He is nothing but skin and bones. He is suffering and I think the fluid is prolonging his life.

I am ready to walk. I don't get the info I need to do my job properly and am overwhelmed on this unit.

Please advise!!

Thanks!!

__________________________

In His Grace,

Karen

Failure is NOT an option!!

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Specializes in Geriatrics.

Has anyone talked to the Hospice nurse that is in charge of his care?? If he is nearing the end stages of the dying process I would image that the fluids could be d/c. Most of our hospice patients are on Q hour roxinal along with ativan. It is aweful to know that someone is suffering. I think the most important thing is to keep him comfortable (i'm sure you knew that though). Does he have any family that has any kind of input about the situtation?? We just had a lady that suffered a CVA and she was put on hospice. The family knew there was no hope for recovery and opted for "comfort measures only". She was unresponsive so therefore had no nutritional intake or fluids. We gave her routine Roxinal and tylenol supp for her spiked temp. Everyone's dying process is different. She lasted about 2 and a half days but I have seen others last up to 3 weeks. I think in your situation the family and/or the hospice nurse needs to be notified and have specific instructions as to what orders are to be carried out.

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Specializes in Telemetry, Case Management.

Should have called the hospice nurse in charge of his case. They usually were very good about getting new meds started,changing things around to make pt more comfortable. We used to have hospice come in one of the LTCs I worked out and they were really great, did most everything other than hands on care (and sometimes that too if a need arose) for the pt.

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Specializes in Too many to list.

Right, call the hospice nurse. Also, there should be written hospice protocols for you to follow in the patient's chart so that you are not guessing what to do. I have to say, though, I don't see hospice patients being on IV fluids.

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When hospice is in LTC they are making the majority of the money for the resident........it is their responsibility, that is what they are getting paid for. Call the hospice nurse and document, document, docment.

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at the end of life, ivf does nothing in terms of comfort.

rather, it adds to ones' discomfort as circulation and perfusion shut down.

that needs to be dc'd asap.

DO call the hospice nurse/agcy immediately.

there should be hospice notes in the chart: read the plan of care.

prn apap/ibuprofen and cool cloths to head, axilla, groins.

ativan is often not tolerated in the elderly population; just a consideration.

most important and bears repeating, call hospice w/a detailed, brief report on pt.

and yes, document everything.

leslie

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