Category: Nurse Skills
Articles involving nursing skills and techniques.
Mottling of Skin Near Death
As a caregiver or family member, it can be challenging to witness the changes that occur as a loved one approaches the end of their life. One such change that may occur is mottled skin, also known as livedo reticularis. Understanding what mottled skin is and its significance in the dying process can help you provide the best care and support to your loved one during this time.
How to Use the Pain Assessment in Advanced Dementia Scale (PAINAD) to Determine Discomfort in Your Loved One with Dementia
If you have a loved one with dementia, it can be difficult to know if they are in pain or discomfort. The Pain Assessment in Advanced Dementia Scale (PAINAD) is a tool that can help you determine if your loved one is uncomfortable. The Pain Assessment in Advanced Dementia Scale (PAINAD) is different from other pain assessment tools for people with dementia in several ways:
Understanding Heart Failure Stages and Assessment
Heart failure is a complex medical condition that can impact the quality of life of patients, especially those in hospice care. As a hospice nurse, assessing the heart failure stage is crucial to providing appropriate care accurately. This article will explore the New York Heart Failure Classification System, its stages, and how to assess patients for their stages. Additionally, we will emphasize the importance of documentation in compliance with Medicare guidelines for terminally ill patients with heart failure.
Importance of Medication Reconciliation in Hospice Care
Medication reconciliation plays a pivotal role in hospice care, ensuring terminally ill patients receive safe medication regimens. This process involves maintaining an accurate medication list to prevent adverse drug events. It's essential at various stages, including admission, recertification, and changes in condition. Healthcare professionals should be familiar with tools like the Beers Criteria and STOPP/START criteria to identify potentially inappropriate medications and prescribing omissions in older adults.
Early Detection of Serotonin Syndrome in Dementia Patients: Three Case Studies
Serotonin syndrome is a potentially life-threatening condition caused by an excess of serotonin in the body. Detecting this condition early is crucial, but it can be particularly challenging when dealing with dementia patients due to communication barriers and the complexity of their symptoms. In this article, we will present three case studies that highlight the early detection and successful management of serotonin syndrome in patients with different types of dementia: Alzheimer's disease, vascular dementia, and Lewy Body Dementia.
Understanding Serotonin Syndrome: A Comprehensive Guide
Hospice nurses assess the status of the patient's journey towards the end of life every nursing visit. Situations where a reversible condition can drastically impact the patient and the hospice assessment can occur. If it is not caught, it is potentially mistreated, leading to increased discomfort and a faster death, often involving increased suffering. One of the common clues that someone is getting closer to dying is increased agitation and restlessness.
Are you aware of Serotonin Syndrome?
Trigger Words for Hospice Nurses: Assessing End-of-Life in Two Weeks or Less
Discover key indicators for end-of-life care in hospice. This guide highlights ‘trigger words’ that signal a patient’s final days, aiding nurses and caregivers in providing compassionate support during the most critical moments.
Unmanaged Pain in Dementia Patients
Dementia is a condition that affects millions of people worldwide, and it can cause a range of symptoms, including pain and discomfort. Unfortunately, pain is often under-detected and undertreated in people with dementia, leading to significant suffering and a reduced quality of life. In this article, we will explore the prevalence of pain among dementia patients, the impact of unmanaged pain on their quality of life, behavioral changes that may indicate pain, and the use of the PAINAD pain scale as a tool for assessing and managing pain in dementia patients.
Unlocking the Power of Validation Therapy in Compassionate End-of-Life Care
In the realm of hospice care, where empathy and compassion are paramount, a remarkable approach called Validation Therapy has emerged as a beacon of hope and comfort for individuals facing dementia and cognitive disorders in their final journey. As an experienced hospice registered nurse case manager, I've witnessed the transformative impact of Validation Therapy on patients, allowing them to find solace, regain their self-worth, and experience a sense of dignity during their end-of-life phase.
Reviewing Hospice Eligibility
It’s essential to familiarize yourself with the key local coverage determination (LCD) facts for different terminal illnesses to avoid admitting patients who are not eligible for services only to be required to refund the money back to Medicare; otherwise, only have the patient on for one benefit period then discharged for failure to decline. These determinations provide guidelines on the coverage of hospice services for specific conditions. If you are the admitting nurse, please do not just admit because you were told to admit by someone, regardless of the position or standing of the person or party that told you to admit. Use your critical thinking and clinical judgment skills to evaluate the patient for admission. Most doctors will write "evaluate and treat" or something to that effect; never lose sight of the "evaluate" portion of the doctor's order.
Based on the provided PDF files, as noted in the resources section below, let’s explore some essential information for each terminal illness.
Understanding Discomfort: Distinguishing it from Pain While Caring for Your Terminally Ill Loved One
Caring for a terminally ill loved one is a profound and challenging journey that requires compassion, understanding, and a willingness to alleviate any discomfort they may experience. In this guide, we will explore the concept of discomfort, its distinction from pain, and the importance of recognizing and addressing discomfort in addition to pain. You'll be better equipped to provide holistic care that enhances your loved one's quality of life during this sensitive time.
Throughout your loved one's illness, you might find yourself thinking that they don't require "pain medication" because they don't seem to be in pain. They might even respond with a direct "no" when asked about their pain. However, are you aware that most types of pain medication can alleviate discomfort? Did you also know that your loved one could be feeling uncomfortable without necessarily being in severe pain? Nonetheless, it's important to recognize that their discomfort requires the same treatment as if they were in pain.
Breathing Patterns Before End of Life: Critical Clues for the Last Hours!
Understanding the final breath: This article explores the critical breathing patterns observed in the last hours of life, offering insights for caregivers and family members to prepare for the end-of-life journey.
The Power of Empathy in Hospice Care
It's common in nursing to be told by others that you shouldn't be a nurse, and some may even call you a "fake nurse" if you don't meet their standards of what they think is required to be a nurse. The first time I was told I could not be a nurse was by an elderly woman who believed only women could be nurses.
Empowering Hospice Nurses: Conquering Medicare Audits and Improving Documentation for Better Patient Care
This article provides valuable insights for hospice nurses on improving documentation to conquer Medicare audits and ensure claims are not denied due to insufficient evidence of terminal prognosis. The author shares real-life examples of visit narratives before and after implementing documentation best practices learned from an expert. The tips focus on capturing negative condition changes, disorientation levels, and functional decline to paint a clear picture of the patient's terminal state, ultimately leading to better patient care.
Educating Facility Staff on What Matters for Terminally Ill Patients
Educating nursing home staff on hospice care priorities like shifting focus from vital signs to comfort, managing symptoms like pain/breathlessness, providing psychosocial support, end-of-life planning, and bereavement care is crucial. Hospice emphasizes quality of life over curative treatments. Effective symptom management through medications and non-pharmacological approaches enhances patient comfort. Open communication, empathy, and respecting patient autonomy are essential. Hospice prepares families for the dying process and grief counseling.
Review of the Hospice Documentation Master Bundle
Whether you are a new hospice nurse or an experienced one like me, I would hope that it is your desire to prove and support continued hospice eligibility for your patients and families. In my years as a hospice nurse, I've always felt the training on what words and phrases to use to support hospice eligibility was weak compared to the training received in other areas of nursing. Now, you have a means of getting the education you need in a very portable setup that you can take with you, use as you see fit, and bloom!
A Day In The Life Of A Hospice Nurse
What does a typical day, a typical week look like for a visiting hospice registered nurse case manager look like?
Understanding HIS Requirements for Medicare in Hospice Care
One crucial aspect for new hospice nurses to grasp is the Hospice Item Set (HIS) requirements. In this article, I’ll explain the HIS requirements for Medicare, providing you with a comprehensive understanding to ensure compliance and quality care delivery.
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.
Effectiveness 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.
Detecting 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.
What Hospice Nurses should assess every visit
Hospice nurses play a vital role in providing quality care and comfort to terminally ill patients and their families. They must make accurate and timely assessments of the patient’s condition, needs, and preferences every visit. This article will outline the key aspects that hospice nurses should assess every visit, in addition to the standard physical assessment.
Should 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:
Frequency of Changes in Condition as an Indicator of Approaching Death
Recognizing the velocity of changes in a patient's condition is crucial for hospice nurses. By understanding the pace of changes in vital signs, symptoms, functionality, and more, nurses can anticipate needs, adjust care plans, and communicate the prognosis effectively with patients and families. The article provides guidelines on interpreting the velocity to estimate the time a patient has left.