Palliative Care:
A Guide
A Nurses guide to ensuring a dignified death for all of our patients.
Patient Swallowing and Medication Administration
When a nurse first suspects their patient has crossed into the pre-active phase of dying initial assessment of swallowing ability is required. Sometimes the family will request a speech consult and this is okay. Medication adjustment is critical so immediate notification to the physician should take place.
The physician should discontinue medications no longer needed, such as supplements and other non-essential medications. Initiation of sublingual medications to address pain, dyspnea, anxiety, nausea, and vomiting, and per rectum medications for constipation should take place.
It is critical at this point in the patient’s phase of dying that these medications are ordered. There is nothing worse than needing a medication and it not being available.
As the patient progresses through this phase and enters the active phase continued assessment is crucial.
When it is determined the patient can no longer swallow, the nurse should request from the physician subcutaneous medication administration. Additionally, all other medications can be discontinued at this time.
Reducing the suffering of our patient’s is a core value of nursing. Close monitoring of palliative and hospice patients is key to ensuring adequate quality of care.
Excellent video on what it's like to be a palliative care nurse. The best description of the types of pit-falls that nurses in this field can fall into.
Enjoy this indepth perspective from a palliative care nurse.
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