Palliative Residents

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Specializes in LTC.

Hey all,

I started working in ltc last march and have had some residents who were palliative. Some passed after being about 2 weeks palliative and others much quicker. The one's who left faster in my experience so far were residents whose breathing were tachypneaic (resps in the 30's) and a couple who had problems with their blood. One resident had been reported coughing blood and another had stopped receiving her platelet transfusions.

I worked with the resident who stopped receiving her transfusions a couple of days ago on the night shift. The evening shift nurse told me about her I'm not sure when exactly her blood transfusions stopped but they were stopped because her veins couldn't be found anymore...... The evening nurse said she got palliative orders and also explained that the resident had been having long blood clots from everywhere. Had some congested breathing as well. I put a new subcutaneous line in because the old one was falling out, then gave scheduled dose of hydromorphone for 12am. The resident had yellowish green, bloodtinged discharge coming out of her right nostril and her resps were 17. She passed away at 0230. I know the residents are pallitative and expected to die but I can't help but feel guilty when I administer the right dose of hydromorphone, then the resident just dies. Should I be worried about this? What's the quickest you've experienced a resident go?

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Specializes in Gerontology, Med surg, Home Health.

Unless you gave an extremely high dose, the patient didn't die from the drug, they died from their illness. There is no timeline. I've seen people last for 3 weeks with no food or fluids and others die in a day or two.

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Specializes in LTC.
Unless you gave an extremely high dose, the patient didn't die from the drug, they died from their illness. There is no timeline. I've seen people last for 3 weeks with no food or fluids and others die in a day or two.

Just out of curiosity, for the people you say you've seen die in a day or two, what were their illnesses?

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Specializes in LTC, Hospice, Case Management.
Just out of curiosity, for the people you say you've seen die in a day or two, what were their illnesses?

1st - As a 30+ year nurse in LTC and hospice, I totally agree with Capecod. Nurses get all wrapped up in "the last dose of narcotic medication killed someone" - No, they have a terminal illness and THAT is why they died. If you are the nurse withholding that last dose of narcotic medication on a terminal resident than you would be allowing that poor soul to pass in pain.

2nd - Your question as to their illness - that answer is to vast to give any reasonable explanation. Most of our resident have multiple comorbidities and there are SO many illness and conditions that play into this. I would highly recommend some reading on death and dying, maybe a visit to read some of the info over on the hospice forum. Death and dying can be a hard thing for a new nurse to learn to deal with but your end of life residents and their families will greatly benefit if you grow a comfort level with this.

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Specializes in LTC.
1st - As a 30+ year nurse in LTC and hospice, I totally agree with Capecod. Nurses get all wrapped up in "the last dose of narcotic medication killed someone" - No, they have a terminal illness and THAT is why they died. If you are the nurse withholding that last dose of narcotic medication on a terminal resident than you would be allowing that poor soul to pass in pain.

2nd - Your question as to their illness - that answer is to vast to give any reasonable explanation. Most of our resident have multiple comorbidities and there are SO many illness and conditions that play into this. I would highly recommend some reading on death and dying, maybe a visit to read some of the info over on the hospice forum. Death and dying can be a hard thing for a new nurse to learn to deal with but your end of life residents and their families will greatly benefit if you grow a comfort level with this.

Started reading this morning

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Specializes in Geriatrics w/rehab, LTC, hospice patient.

I would say maybe in a night or two? But that was after they significantly started to decline. They'd actually been on hospice for about a month, although for the majority of it they were so alert you wouldn't necessarily know it. As others have said, the resident died from their terminal illness; you just helped them to pass in less pain. Maybe that last dose was just what they needed to relax and let go.

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Specializes in LTC.

Had another death. This resident when I was working with ther a couple of days ago was not looking like her normal self. According to report, wasn't having a whole lot of intake, just her pills, and a few sips of fluids. She was under the other nurse's care a couple of days ago.

Last evening, the staff obtained palliative orders. One of the rn's told me, "she might go tonight." Blood pressure dropped in the 50's systolic. No audible congestion, she wasn't even that sick! Had a busy night, a resident was on the floor and had a skin tear at start of shift, one resident was restless, another complaining fo pain. Finally came to see the resident at 12 am. Still not doing good. Passed away at almost 2 am. Had to cover 1 floor with 62 residents and another floor with 48, other nurse had to cover the other unit with 48 residents and another unit with 39. There were a couple of residents who were on isolation on my side of the facility.

I've been struggling so much with prioritization. How do you do it all? Has anyone else ever shared this struggle? I could really use some advice. Feeling so awful about my palliative care right now

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Specializes in LTC, Assisted Living, Surgical Clinic.

I work with some pretty seasoned nurses that STILL struggle with giving that last dose of roxanol, although we work closely with hospice and have been educated ten ways to Sunday on pain control. I have found, in fact, many families request the roxanol/lorazepam/atropine be given ATC on schedule to ensure their loved one is not in pain. Never felt that I caused a death giving pain meds as ordered, and I try to be in that room right at scheduled time with them even if it's q2h and my day's gone to pot.

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Specializes in LTC.
I work with some pretty seasoned nurses that STILL struggle with giving that last dose of roxanol, although we work closely with hospice and have been educated ten ways to Sunday on pain control. I have found, in fact, many families request the roxanol/lorazepam/atropine be given ATC on schedule to ensure their loved one is not in pain. Never felt that I caused a death giving pain meds as ordered, and I try to be in that room right at scheduled time with them even if it's q2h and my day's gone to pot.

Same here, i'm not one to take a break when I've got 24 residents and one of those residents is palliative on the locked down unit

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Had another death. This resident when I was working with ther a couple of days ago was not looking like her normal self. According to report, wasn't having a whole lot of intake, just her pills, and a few sips of fluids. She was under the other nurse's care a couple of days ago.

Last evening, the staff obtained palliative orders. One of the rn's told me, "she might go tonight." Blood pressure dropped in the 50's systolic. No audible congestion, she wasn't even that sick! Had a busy night, a resident was on the floor and had a skin tear at start of shift, one resident was restless, another complaining fo pain. Finally came to see the resident at 12 am. Still not doing good. Passed away at almost 2 am. Had to cover 1 floor with 62 residents and another floor with 48, other nurse had to cover the other unit with 48 residents and another unit with 39. There were a couple of residents who were on isolation on my side of the facility.

I've been struggling so much with prioritization. How do you do it all? Has anyone else ever shared this struggle? I could really use some advice. Feeling so awful about my palliative care right now

those ratios are too high, even for LTC on night shift. Did a nurse call in, or is that standard staffing there?

My only advice would be that palliative cares take priority over tasky stuff, but I'm sure you knew that already. I have seen some nurses get tunnel vision with Med pass.

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Specializes in LTC.
those ratios are too high, even for LTC on night shift. Did a nurse call in, or is that standard staffing there?

My only advice would be that palliative cares take priority over tasky stuff, but I'm sure you knew that already. I have seen some nurses get tunnel vision with Med pass.

Yes, it was snowing really bad and the nurse who was supposed to come in couldn't make it, but this the normal ratio. I'm realizing now that, yes, I should have tried to drop everything just to take better care of this resident.

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