Managing symptoms for a �good death�

[NRSKarenRN]

found at nursing 2006:

november 2006

volume 36 number 11

pages 58 - 63

managing symptoms for a "good death"

marylou kouch aprn, bc, msn

contact hours: 2.5* expires: 11/30/2008

What's a good death? Most patients facing the end of life say it means freedom from pain and other distressing symptoms. 1 as nurses, we can play a major role in easing their way to a good death.

Managing symptoms in the last phase of life is especially challenging because you probably won't have the benefit of diagnostic studies to help you assess signs and symptoms. But as a nurse, you bring unique qualities to the table: assessment skills, a partnership with the patient and her family, and the determination to bring comfort.

In this article, I'll present a case study to illustrate the most common end-of-life symptoms, including pain, fatigue, dyspnea, and gastrointestinal problems. Whether your patient has all of these symptoms or only a few, you'll learn how to keep her as comfortable as possible.

[grbrico]

We use atropine gtts for emergencies and keep those in a comfort box. But Scop patches work even better. We use the Atropine gtts (typically opthalmic gtts) under the tounge... 2 gtts every 4 hours as needed. We get the scop patches as soon as we can... 1-3 patches every 72 hours.

[powerflash]

I'd like to have nurses talk about atropine, I've given more then ordered at the last hours.( It does help) WHAT ARE YOUR FEELINGS ABOUT THIS?

[leslie :-D]

I'd like to have nurses talk about atropine, I've given more then ordered at the last hours.( It does help) WHAT ARE YOUR FEELINGS ABOUT THIS?

let's face it:

the dosages a/o, are inadequate.

you do what you need to do, to get symptoms under control.

leslie

[tewdles, RN]

I agree that the atropine dosage is inadequate when a patient is having an acute crisis with pulmonary congestion. In those instances I consider injectable scop to get a quick handle on it and then try to maintain with Atropine or levsin or the TD Scop. There certainly is benefit in the CHF patient (and many others) transitioning toward death in a slightly dehydrated state, the natural process usually takes care of this but there are some poor folks who come to us dying and wet. If you can plan for that transition it helps everybody involved. Remember to stress good mouth care to the caregivers when using these meds. Dry mucous membranes are a miserable side effect.

As clinicians we have to be cautious about these meds outside of the terminal phase. I did a PRN visit one night for a youngish woman with lung Ca using TD Scop for routine symptom management, she got a bit dry and developed mucous plugs with some significant atelectasis. She didn't want to go to the ER so I stayed with her and accomplished quite a bit of pulmonary toilet and got her comfortable again. (thank the LORD for my NICU/PICU days)

About the "good death" part. As a hospice nurse I define it differently than the patient or the family might. Not because my goals are different from theirs but because I have goals in addition to theirs. So for me, a "good death" is what ever the family and patient say it is plus all of the comfort and peace I can provide them in my role as case nurse.

[powerflash]

HELLO! Yes Atropine dosage at this point in time are too low.I've given more in the last hours of death and it does help,ALOT!!!!! Our Medical Director knows we do it,but there is no written order. Cancer.org give .4ml sq ever 15 min. How can "WE" get this info out and help more pt.s have a more peaceful death?? I hope y'all will talk this out with me. Thanks

[bunsterj]

I was hoping to read the article, didn't care about the CEU's. Found that the article was nearly $8 at this time. I do realize this is an old thread.

[req_read]

Hi Leslie…

Referring back to page 36, Post # 353 of this thread…

I’ve been thinking about this, for a year and a half or so (referring to your comment, “it's all good.

it's really, all good.”)

It’s making more sense to me now, I think, but has left me wondering what your response might be to a question.

Now first let me say, I would not ask most people this question… but you, I would… because your answer, should you choose to give one, would be felt as opposed to learned. Nor do I think you would be cowed by the question… although I realize that posting it here might be a horse of a different color.

Anyway, the relevance of the following question to a thread addressing “good death” is core, so here it is: What is the purpose of life? (Meaning “life” in the rather limited sense of a temporary earthly experience.)

Or the question might be stated thusly:

What are we doing here? What did we come here for? What is the point? What is there to gain? Why go to all this trouble?

Warmly,

Michael

[knurse8]

"I did a PRN visit one night for a youngish woman with lung Ca using TD Scop for routine symptom management, she got a bit dry and developed mucous plugs with some significant atelectasis. She didn't want to go to the ER so I stayed with her and accomplished quite a bit of pulmonary toilet and got her comfortable again. (thank the LORD for my NICU/PICU days)"

"pulmonary toilet" I am trying to picture what this is?

Would you kindly elaborate?

[knurse8]

RE: Twedles reply no 363

"pulmonary toilet" this has been racking my brain and producing strange images.

Would you kindly elaborate?

[leslie :-D]

Hi Leslie...

Referring back to page 36, Post # 353 of this thread...

I've been thinking about this, for a year and a half or so (referring to your comment, "it's all good.

it's really, all good.")

It's making more sense to me now, I think, but has left me wondering what your response might be to a question.

Now first let me say, I would not ask most people this question... but you, I would... because your answer, should you choose to give one, would be felt as opposed to learned. Nor do I think you would be cowed by the question... although I realize that posting it here might be a horse of a different color.

Anyway, the relevance of the following question to a thread addressing "good death" is core, so here it is: What is the purpose of life? (Meaning "life" in the rather limited sense of a temporary earthly experience.)

Or the question might be stated thusly:

What are we doing here? What did we come here for? What is the point? What is there to gain? Why go to all this trouble?

Warmly,

Michael

oh my gosh, michael...tonight is the very first time i have read your post.

the only reason i came to this forum, is because i noticed that someone had posted on it.

it was only reading through the last page that i realized you asked me this question 1.5 yrs ago.

admittedly, i became a tad overwhelmed with your question...

yet you have already touched on the reason for feeling as i do:

it is because i lack the capacity in verbal articulation...it is too much of an intellectual process for me, and my mind just does not work that way.

it is only my senses that convey a feeling of right/wrong, good/evil, etc.

moving onward - i just cannot answer your question right now.

it is a question that i ponder on a daily basis, trying to make sense of it all.

there is much i accept, where others probably do not...

such as pain and suffering, both physical and mental.

i fully believe there are energetic forces present that influence all human actions on earth...contrast with a yin/yang principle.

how these energies manifest themselves alone, and/or in combination with human thought, feeling, along with other energetic occurences (natural phenomena)...

one needs to consider how ea acts alone, and then how ea force synergizes one's potential...

and finally, what it means...or what it's supposed to mean or achieve.

just know that i am acknowledging your question and i will get back to you one way or the other.

i don't know when but you won't have to wait 1.5 yrs...i promise you.

this is especially challenging for me, as you have already sensed.

to try and even attempt an answer - well, it may prove impossible...but for you, i will indeed try.

leslie xo

[NRSKarenRN, BSN, RN]

RE: Twedles reply no 363

"pulmonary toilet" this has been racking my brain and producing strange images.

Would you kindly elaborate?

Pulmonary Toilet? Huh??? - Page 2 - Nursing for Nurses