Vital Signs

[RNinRubySlippers, BSN, RN]

I am just curious what your facility policy is re: taking VS on Palliative pts? It is actually a pet peeve of mine and feel it is quiute invasive at end-of-life. What say you?

[doodlemom]

In the nursing home that we serve, we usually get orders to d/c vital signs and accuchecks when a pt stops eating. Our inpatient facility does not do vitals if the pt is actively dying.

[leslie :-D]

no, we don't do vs where i work.........sometimes i'll take a quick pulse to get an idea how tachycardic the pt is, and plan interventions accordingly. each pt. is unique in presentation.

leslie

[silverwillow]

no, we don't do vs where i work.........sometimes i'll take a quick pulse to get an idea how tachycardic the pt is, and plan interventions accordingly. each pt. is unique in presentation.

leslie

I agree, and do them on a case-by-case basis. Often, family members expect it, perhaps trying to keep their own type of 'death gauge' going, so they can prepare themselves. I often remind them that I would be happy to take the patient's vitals, but I also review signs and symptoms of dying with them so they can know what to watch for as the time draws near since vitals alone are often not a good indicator.

Sometimes when caring for a fairly alert dying person who is alone, I feel kind of guilty when taking their vitals, almost as though am I nonverbally asking "are you dying yet?"

I do vitals about once a week on all of our patients, mainly for the chart's sake.

[req_read]

Another point about dying patients and VS is this…

When we are dying there are different things going on which can attract our attention. Generally speaking, those things can be divided into 2 categories; 1- those things that are physical and 2- those things that are not physical.

Physical concerns are obvious; e.g. pain, nausea, skin breakdown, ease of breathing etc.

Non-physical concerns are more varied and ultimately, more important; e.g. things like resolving conflicts and unfinished business, having meaningful interactions with our closest friends & family and becoming more aware of the spiritual nature of who we are to name a few.

After having “lived” for some time (usually several decades) in a physical body, we humans are inclined to think of ourselves as bodies. Dying process helps us to think differently, but sometimes it can be hard to establish new thinking patterns.

When working with the dying it is better to encourage the patient & family to shift focus from the physical to the non-physical… after all, the person is shifting from a physical to a nonphysical state of being. Constantly taking VS is to focus on the physical… which is contrary to what is happening to the patient and contrary to the goals of treatment.

[bay bay]

Interesting and valid points Red.. Thank you!

[rosemadder]

We obtain vitals once per 12 hour shift but it's not written in stone. If the patient is sleeping...we don't wake them up. If we can't get readings we don't worry about it.

[suebird3]

In my facility, we usually get a quick set of vitals on both Hospice and non-Hospice patients when we notice that "decline". I have noted that the vitals tend to "warrant" a call to family/Hospice/etc. Just an observation.

Suebird :)