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new RN and new hospice nurse-need help!

Hospice   (2,517 Views 8 Comments)
by ajitamamasita ajitamamasita (Member) Member

2,786 Profile Views; 39 Posts

I am a new hospice nurse (started Jan 2011). I am always, with every visit assessing for pain, and in most of my pts. I'm looking for non verbal pain indicators since many can't communicate. I recently saw a pt. who was actively dying. The pt. appeared comfortable and was resting in bed with a HR of 126. I realize that 126 is a high hr, but the way I understand it pts. who are "active" can be very bradycardic...or very tachycardic, so I didn't think of this as a clue to my pt. being in pain. I was looking for grimacing, facial expressions, moaning, restlessness, rigidity, etc. How does one know if a high bp reading, or an increased HR truly are "pain indicators?" I appreciate any help with this :)

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2 Posts; 503 Profile Views

Hello, thanks for asking this very important question. When I was a new hospice nurse I always struggled with this too. FLACC scale is one of the best indicator of pain and is used by many disciplines http://www.hospicefellowship.com/pdfs/PainAssesmentTool.pdf

In addition, many times physical pain is a symptom deep of psycho-spiritual turmoil we all feel during any major life transition specially during death and dying. These needs are expression of love, forgiveness, safety for self and others, permission to move on as well as closure and legacy. It is important to proactively and compassionately address these issues. It is also imperative to note that most of the time, the patient and the loved ones are not consciously aware of these issues

During my experience as a hospice nurse, I introduced these issues early on to help the dying and their loved ones. I noticed a tremendous improvement in the quality of life as well as decreased agitation and pain when their psycho-spiritual needs were addressed. In addition, I have witnessed a great number of beautiful, peaceful and graceful dying experiences , which i believe is a direct result of proactively addressing the needs that go beyond the physical discomfort.

I hope this helps. This is a very vast topic and difficult to explain in a few minutes. If you have further questions, you can connect with me at https://www.ThroughLifeAndDeath.com

Mnay Blessing,

Shahina Lakhani RN, MSN

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tewdles has 31 years experience as a RN and specializes in PICU, NICU, L&D, Public Health, Hospice.

3,156 Posts; 30,759 Profile Views

Many patients reach a point in their act of dying that they cannot demonstrate nonverbal signs of pain or discomfort. It is important that we consider how comfortable that person was before they became that obtunded. It is fair to assume that if they were painful when they were responsive that they may be painful now.

This is not an easy call and often requires a very good relationship with the family or facility staff who are providing the ongoing care. It is important to consider their fears and feelings in this plan, all the while advocating for the patient.

Good luck.

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ErinS is a BSN, RN and specializes in Hospice.

347 Posts; 5,229 Profile Views

I always continue any routine medication a pt was on before entering their dying process. I also make some assumptions- pre-medicate for pain prior to interventions that cause discomfort- like bathing. The other thing that I tell families and caregivers is at the end of life I feel we should be erring on the side of comfort. If in doubt, we probably need to be treating for not only pain, but often I think people have a lot of anxiety during the active dying process that should be treated. This is a tough thing, and I am not sure there is any way to know, other than maybe to give a small dose of pain medicine and see if the vital signs change?

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SuperrBaddRN specializes in hospice.

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It depends on the pts disease process...I woundnt go off of the HR alone..was the pt just repositioned? What HR is normal for the pt? was there any stimuli in the room? family members? I always look at all the vitals in addition to any grimacing/frowning/moaning/restlessness to judge if the pt is exp. any pain or discomfort. :redbeathe

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11,191 Posts; 53,759 Profile Views

It depends on the pts disease process...I woundnt go off of the HR alone..was the pt just repositioned? What HR is normal for the pt? was there any stimuli in the room? family members? I always look at all the vitals in addition to any grimacing/frowning/moaning/restlessness to judge if the pt is exp. any pain or discomfort. :redbeathe

absolutely.

tachycardia, htn can be signs of other things other than pain.

certain meds/txs can cause it: the cessation of certain meds can also cause it.

dehydration and stress...meaning, sev'l etiologies at hand here.

when it comes to pain, one really does have to eval the big picture.

it's a skill that doesn't come readily.

leslie

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