eternalsunshine

Hi Melnee I have to agree with Oceansunset on this, I have been a Hospice & Palliative care RN for a number of years, both in the UK & USA. This is not an easy exam & I recommend that you have some practical experience before you undertake this exam. Some of the best materials you can find & just really useful information is right on this forum! :) There are so many interesting and helpful postings, good luck! :)

Oh my gosh, poor lady, must be so awful for her What about using some Vaseline gauze? i had the exact same problem with a fungating wound on a leg recently, and it was causing it to bleed when removing dressings, this worked fantastic and the dressings just came off very easily with no discomfort for the patient.

Could you use a topical opioid? I have used these in the past with very good results.

I currently have a patient who I have had ongoing challenges with managing bone pain. He is now on Decadron along with scheduled Methadone which appears to be effective.

Prochlorperazine and Chlorpromazine can also be used :)

I get a little concerned when I hear nurses doing this, my first point would be, when you assess the patient (particularly if they are non verbal or minimally responsive), are they agitated or anxious because they are in pain or they have Dyspnea? I always consider what the source could be first. I normally say to that to the family too when educating. I personally think good practice should be to give Roxanol first if you are addressing Dyspnea or pain, if the patient is still agitated on further evaluation, then I would go ahead and given Ativan, but I prefer to try and identify if there is something causing the agitation first, otherwise you could be overlooking what is causing the agitation/anxiety. Hope that helps :)

Wow, Atul Gawande's article is very long but interesting! There is one statement in there that stood out for me: "You live longer only when you stop trying to live longer". I will be checking out that Ira Byrock book too, thanks!

As one of the posters points out, the evidence is mixed. I think there are other factors which depend on its absorbency, skin type, diaphoresis etc. Also I was once told that it is carried in a pleuronic agent, so it should for maximum effect, be applied to the same area, therefore, when I ever apply it, I always signs where I have applied it, i.e. left wrist. As there is no firm evidence, I often wonder how much of the actual drug is absorbed.

I work as an RN in an In patient unit. I have six patients, with one CNA who works with me.

Jonga, many thanks for the recommendations :) Have got the first 3 you list, but have not heard of the handbook for Mortals so will check that one out. Thank you! :)

Angila, so sorry to read your story I highly recommend the book "Final Gifts", it talks a lot about how patients nearing the end of life use symbolic statements such as your father did. I had a patient recently who spoke of "going home" but he wasn't referring to where he lived. This book is invaluable and may help to give you some comfort & a clearer understanding. It's written by two Hospice Nurses. http://www.amazon.com/Final-Gifts-Understanding-Awareness-Communications/dp/0553378767

jonga, can you recommend any good books you read? I am always looking out for new reads :)

I have two pairs of these scrubs and would say that their sizing is pretty accurate :)

I recently had to give a patient Methadone rectally. he had an order for this in case he began to experience Dysphagia, which he did. The rectal dose was lower than the oral dose & our Medical Director explained that absorption was higher rectally, so, what athomas91 states in his first response is correct about how medications are metabolized when taken orally versus rectally. I would have this in the back of your mind if you ever have to give something rectally and perhaps just double check & clarify the dosage before administering rectally.

I know this is an old post, but for any other newbie nurses who are looking to find answers to this question, here is a great video! ?