Palliative and End of Life Care will be the care you provide to patients to promote comfort and ease suffering. The aim of this care is not necessarily for curing the patient of their illness, but rather reducing the amount of physical, emotional and spiritual pain/suffering they may be experiencing. The important aspects of palliative care will be to provide effective and regular pain control, decrease the occurrences of nausea and vomiting, decrease episodes of shortness of breath (dyspnea), regular mouth care and repositioning, provide emotional support to patient and the family.
Palliative Pain Control
Be prepared to be giving pain medications quite regularly (every 1 to 2 hours) with most palliative patients. In many instances, the patient will not be able to swallow so alternate routes of pain medications will be administered. For example, dissolvable under the tongue (SL), per rectum (PR), subcutaneous injection (SC), intravenous (IV to be given by nurses only).
In addition to scheduled pain medications, you will be required to give patients breakthrough medications when needed. These pain medications are to help with any pain crisis the patient may experience. These breakthrough pain medications are called PRN or as needed.
For example, your Patient was scheduled to receive Morphine 2mg every 1 hour. At 11:00 you gave your Patient Morphine 2mg as directed. However, at 11:20 your patient complains that the pain control is not sufficient and requires more pain medication. You review your patient’s MAR (medication administration record) and discover that your patient is able to have “PRN or “As needed” medications as well. You note that your patient can have Morphine 1mg every hour as needed. In this instance, you are able to safely give your patient Morphine 1mg now.
Most common pain medication for palliative patients will be Narcotics: Such as – Morphine, oxycodone, Hydromorphone and methadone.
Side effects of Narcotics that you must be on guard for are: Sedation, drowsiness, decrease breathing (respiratory depression). If you have any questions about these side effects, speak to your supervisor.
Additional side effects of narcotics are: Constipation, urinary retention, dry mouth, delirium.
Palliative Nausea and Vomiting
Palliative patients may not have much of an appetite as they once did before. This is usually due to the worsening of their disease process, and associated nausea and vomiting.
Medications that are beneficial for nausea and vomiting are Metoclopramide, Haldol, Ondansetron, Gravol.
With any abdominal cramping, Buscopan is a commonly used medication to help with this symptom.
Do not try to force feed these patients. Family members should be educated that increasing the amount of food the patient eats or drinks will not prevent them from losing more weight as this is most likely a part of the disease process. Instead, allow the patient to have small frequent meals through out the day. Give them only foods that they enjoy. Do not be fixated on the nutritional value of the food. You can increase the number of calories they consume by adding rich calories to some of their certain foods. For example, add creams into soups or hot chocolate, sour cream to potatoes, butter and peanut butter to toast. These tips will help richen the flavor and calories.
Mouth Care:
Ensure to provide frequent mouth care as this will also help with motivating the patient to eat more regularly. Use dental sponges and mouthwash as needed throughout the day and after vomiting episodes. Frequent mouth care will also reduce the sensation of dry mouth.
Shortness of breath (dyspnea)
Some patients at end of life may experience episodes of dyspnea or increased secretions in the mouth/throat. This is the persons perception of breathlessness and their reaction to it. Family might be concerned that the patient cannot breath, but reassure them and take action. It is not recommended to suction these secretions but rather give the medication Atropine to help dry up the secretions in the throat. Other medications that may be ordered are antibiotics, cough suppressants, water pills (diuretics), steroids, anti-anxiety medications and narcotics.
If this medication is required you will be taught how to administer it.
Repositioning:
Reposition patient every 1 to 2 hours with extra care and minimal disturbances. Having the patient on a sheet will allow you to reposition them easily and only a few inches at a time. Always give pain medication 30 minutes before repositioning or any other care.
Care Tips for End of Life Patients at Home:
Familiarize yourself with the below image to learn about what signs and symptoms to be aware of when a patient is actively dying and nearing death.
Emotional Support for Patient and Family
You being Present will be the best way you can provide emotional support. Actively listening to the patient and their family about their concerns, feelings, fears and hopes. You do not have to have a answer to any of these that they share with you, simply being present is effective. Silence is also powerful in providing emotional support. If you decide to participate, reading prayers or saying prayers is also helpful. Listen to what the needs of the patient and family are, and do so accordingly.
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