Category: Symptom Management
Articles relating to managing symptoms of terminally ill patients with the goal of maintaining comfort through the natural dying process.
Clues for terminal restlessness often missed for facility patients
One of the hardest portions of the job of a hospice nurse is to identify when a patient has two weeks of life left to live; this can be especially difficult at facilities going through staffing shortages leading to inconsistent caregivers with little to verbally report on a patient’s change of condition. Since being aware of the velocity of declines is extremely important, let’s cover an area that we in hospice (nurses, families, and caregivers alike) can keep an eye on in terms of identifying terminal restlessness which is often a key indicator for one week or less of life.
Read MoreClues for terminal restlessness often missed for facility patientsEffectiveness of topicals for pain and anxiety management
I have seen firsthand the benefits and drawbacks of different medications for managing pain and anxiety in terminally ill patients. Fentanyl patches and Ativan gel are two commonly used medications, but their effectiveness can vary depending on a patient’s build and weight, particularly for very thin or cachexic individuals.
Read MoreEffectiveness of topicals for pain and anxiety managementDetecting Infections in Terminally Ill Geriatric Patients with Dementia
One of the most important roles is detecting and managing infections in terminally ill geriatric patients with dementia. These patients are often at higher risk for infections due to their weakened immune systems, underlying health conditions, and limited mobility. Detecting infections in these patients can be challenging due to their limited communication abilities and other cognitive and physical impairments. However, early detection and management of infections can significantly improve the patient’s quality of life and potentially prolong their life.
Read MoreDetecting Infections in Terminally Ill Geriatric Patients with DementiaShould dying patients be on oxygen?
I have cared for many terminally ill patients over the years. One question that comes up frequently is should the dying patient be on oxygen at the end of life?
I see it from both sides, from hospice intake personnel as well as the admitting nurse — all had it drilled into them over the years that low oxygen saturation must be treated — to families who see how hospital and nursing home staff rush to put someone on oxygen because of low oxygen saturation.
Contrary to widespread belief, most dying patients do not need oxygen. Here’s why:
Read MoreShould dying patients be on oxygen?Presentation: Death, Dying, and Comfort Medications in Hospice Care
As an experienced hospice nurse, I understand that working in hospice care can be emotionally and physically challenging. In this presentation, I will share my knowledge and expertise on the topics of death and dying, as well as comfort medications including morphine, to help guide you in providing the best care for your patients.
Read MorePresentation: Death, Dying, and Comfort Medications in Hospice CareRecognizing and Treating Common End of Life Symptoms
Guide to Recognize and Treat Common End of Life Symptoms provides tips on managing symptoms experienced by those at the end of their lives - Topics such as pain, shortness of breath, respiratory distress, and anxiety, and provides suggestions for medications and complementary therapies to help manage these symptoms.
Read MoreRecognizing and Treating Common End of Life SymptomsDelirium vs Terminal Restlessness
As an experienced hospice nurse, I understand how difficult it can be to distinguish between delirium and terminal restlessness. Both conditions can cause significant distress for the patient and their loved ones, and nurses must be able to tell the difference between them to provide the best possible care. In this article, I will share my knowledge and experience to help new hospice nurses understand the differences between delirium and terminal restlessness and how to rule out delirium.
Read MoreDelirium vs Terminal RestlessnessMorphine and Lorazepam are not euthanizing agents
As a hospice nurse with years of experience, I have encountered many situations where family members are hesitant to allow their loved ones to receive medications such as morphine and lorazepam. One of the main reasons for this hesitancy is the belief that these medications will hasten death, leading to euthanasia.
In this article, I want to address this concern and help family members and friends understand the use of morphine and lorazepam in hospice care.
Read MoreMorphine and Lorazepam are not euthanizing agentsHospice is Comfort Care
I’ve seen firsthand how important it is to understand comfort and discomfort in hospice care. Let’s dive into these terms and how they relate to end-of-life care.
Read MoreHospice is Comfort CareUnderstanding Hospice Comfort Medications
As an experienced hospice nurse, I understand the challenges that terminally ill patients and their families face. One of the biggest challenges is managing symptoms such as pain, anxiety, and nausea. Hospice comfort medications can help provide relief and improve the quality of life for patients in their final days. In this article, we will discuss some of the most used hospice comfort medications and when they might be used for comfort.
Read MoreUnderstanding Hospice Comfort MedicationsUnderstanding PRN Medications for Comfort Care
Hey there, my friend! As an experienced hospice nurse, I understand that managing symptoms for comfort is crucial for terminally ill patients. One of the ways we do this is through PRN medications. Today, I want to help you understand PRN medications and how they can be used in conjunction with scheduled medications.
Read MoreUnderstanding PRN Medications for Comfort CareTerminal Restlessness in the Completely Nonverbal Patient
Terminal restlessness is a common phenomenon that occurs in the final stages of life. It is characterized by agitation, confusion, and distress. It can be challenging to recognize and manage, especially in patients who cannot communicate verbally. This article aims to share insights and tips from a hospice worker who learned how terminal restlessness can manifest differently in nonverbal patients and how to cope.
Read MoreTerminal Restlessness in the Completely Nonverbal PatientAir hunger management at end-of-life
I can count the times I’ve run into air hunger at the end of life as a visiting RN Case Manager for going on five years on one hand. Over the years, I’ve managed patients with pulmonary fibrosis, lung cancers (diverse types), breast cancer, COPD, congestive heart failure, B-cell lymphoma, leukemia, and other diseases that can impact one person’s ability to breathe correctly. Air hunger is rare in my firsthand experiences, but it can happen.
Air hunger often sounds like the person is gasping for breath without regard to the actual respiratory rate (how fast they are breathing); it can also sound like stridor (YouTube videos below where you can hear the difference).
Read MoreAir hunger management at end-of-lifeLiquifying Ativan pills for easier delivery
Ativan, generically called Lorazepam, pills can be easily melted into liquid, and given to your loved one in a syringe. This is typically done vs. putting the pill under the tongue if your loved one has a dry mouth, and the Ativan pills are not melting under the tongue.
The process of melting lorazepam into a liquid will require the following resources:
Read MoreLiquifying Ativan pills for easier deliveryValidation Therapy: A Valuable Tool for Families and Healthcare Teams
Naomi Feil is an expert in gerontology and the creator of validation therapy, which is a means of communicating and acknowledging the internal reality of patients with dementia. When properly utilized, validation therapy can enhance the quality of life of patients with dementia as well as reduce stress on the family and caregivers.
While Naomi Feil and her followers (of which the writer of this article may be considered one, at least in form) focus on using this method of communication to maintain health with the potential for a level of restorative health, I want to share how the concepts of this method can be used during times of crisis.
Read MoreValidation Therapy: A Valuable Tool for Families and Healthcare TeamsThe D.O.G.I. at the window case study
As nurses, when we see an acute change of condition, part of what we should be doing in our assessment is determining if there are reversible or treatable elements that are causing the change. In RN school, Dr. Dagen taught the students about using the D.O.G. mnemonic to help us remember that if a patient has an acute change of condition to check whether there were new medications the patient is taking, their O2 saturation level and their glucose level.
I would further add that as a hospice nurse dealing with mainly geriatric patients that if there is an altered level of consciousness (LOC)/personality change, to also consider the patient may have an infection. For any of you dealing with geriatric patients add “I” for infection, hence “D.O.G.I.” While this mnemonic is typically used for acute changes of level of consciousness, the thought process behind it can be used for other acute change of patient condition as well.
Read MoreThe D.O.G.I. at the window case studyCoughing Up Blood (hemoptysis) Symptom Management
Hemoptysis, or coughing up blood, can be a distressing symptom for patients at the end of their life journey. As a hospice nurse, your expertise in managing this symptom is crucial in ensuring a peaceful and comfortable experience for your patients and their families.
Read MoreCoughing Up Blood (hemoptysis) Symptom ManagementBuccal vs Sublingual for Liquid Medications
Your dying patient has lost their gag reflex as part of the dying process. One of the questions I implore you to ask yourself is what’s the safest route to administer liquid medications? Well, before even going to answer this question, unless contraindicated, make sure the patient’s head of the bed is at least at a 30 to 45-degree angle (I prefer the latter).
The buccal route is the safest route to administer liquid medications at the end of life in my experience. In practice, I strongly encourage you as well as the families we mutually teach to give any liquid medications on the side of the mouth least likely to have spillage — this depends on the position of the patient — and slowly over time giving the medication in 0.25 ml increments allowing for the absorption of the medication switching cheeks as applicable.
Read MoreBuccal vs Sublingual for Liquid MedicationsUnderstanding Terminal Restlessness
Navigating the final days of a loved one's life can be a challenging and emotional journey. One of the signs that can be observed during this time is known as terminal restlessness. As someone deeply rooted in hospice care, I have witnessed various manifestations of this restlessness. Understanding its types, causes, and management strategies is crucial for providing compassionate end-of-life care. This article aims to illuminate the different kinds of terminal restlessness, identify reversible causes, and discuss effective management techniques. By equipping caregivers, families, and healthcare professionals with this knowledge, we can ensure that terminally ill individuals experience comfort and dignity in their final days.
Read MoreUnderstanding Terminal RestlessnessCommon Misconceptions about Morphine and End-of-Life Medications
Morphine is a crucial medication in end-of-life care, but it's often misunderstood. This article debunks common myths about morphine use in hospice, addressing concerns about addiction, hastening death, and sedation. Learn the truth about morphine's role in providing comfort and dignity for terminally ill patients.
Read MoreCommon Misconceptions about Morphine and End-of-Life Medications