nursing things to know for the end of life:
When dying, most people tend to have their respirations change from rhythmic to arhythmic.
Adderall is prescribed for depression in the terminally ill patient because all of the other anti-depressants can take up to several weeks to take effect and we don’t know how much time this person will have left.
Some people before they die, have what is called terminal delerium. This is a sudden onset of activity and restlessness after a long period of little activity. The family is often surprised by this sudden burst of energy. Some people believe this is the mind crossing to the other side and letting go of the things that are the most difficult to let go of.
People that are receiving hospice care at home will often have all of the same medications available for symptom management. These include the following with their indications;
Morphine- will assist in pain management which we all know. But many of the people that I consult with as a Hospice Nurse do not realize that morphine also helps with shortness of breath. In layman’s terms it is useful because it essentially relaxes the lungs and the body allowing oxygen to be better utilized by the body.
Ativan- Ativan is a benzodiazepine and acts to relieve restlessness, agitation, and anxiety. I like to tell people that they know there loved one better than I do. The “faces” of agitation and anxiety are different on everyone. Once the pt has reached full blown panic and is crawling out of their own skin it is usually because we missed the first cues that they needed some relief.
Haldol- Haldol is used for anxiety and agitation but it is a great alternative because it is non-sedating and can be given directly after giving Ativan if the Ativan was ineffective and the caregiver is concerned about over-medicating the patient. Another use for Haldol is in treating nausea and vomitting. Most people that I consult with are unaware of this use for Haldol. Everyone usually decides to use Zofran in the hospital setting because it specifically treats nausea alone while Haldol is a catch all.
If your loved one is restless and agitated and cannot verbalize it, a lot of times it is a simple solution. Think of them like a new born. Do they need to drink, to eat, to pee, to poop…. Are they cold or hot, are the covers wrinkled? Add one more thing to that and we’ve pretty much got all of our bases covered… and that is, do they have a UTI?