End-of-Life Care/Palliative Care

Table of Contents

Aliases

None noted

Patient Care Goals

  1. When providing care for a patient near end-of-life:
  2. Provide relief from pain and other distressing symptoms
  3. Affirm dying as a normal process
  4. Integrate psychological and spiritual aspects of patient care
  5. Offer a support system to help the family cope during the patient’s illness and in their own bereavement

Patient Presentation

Inclusion Criteria

Patient enrolled in hospice or palliative care, or who have advance care directives, experiencing complaints related to the illness for which the patient is receiving those services.

Exclusion Criteria

Complaints unrelated to the illness for which the patient is receiving those services.

Patient Management

Assessment, Treatment, and Interventions

  1. Perform general patient management
  2. If the patient is able to communicate and has the capacity to make decisions regarding treatment and transport, consult directly with the patient before treatment and/or transport
  3. If the patient lacks the capacity to make decisions regarding treatment and/or transport, identify any advanced care planning in place for information relating to advanced care planning and consent for treatment
    1. Guardian, power of attorney, or other accepted healthcare proxy
  4. Attempt contact to hospice agency
  5. If the patient requires pain relief [see Pain Management guideline]
  6. If the adult patient is experiencing severe respiratory distress, consider one of the following:
    1. Assisting patient with home medications
    2. Fentanyl 25 mcg IN, every 5 minutes as needed until respiratory distress improves
    3. Midazolam 5 mg IN once
  7. If the patient has nausea [see Nausea and Vomiting guideline]
  8. If the patient has excessive secretions, provide suctioning
  9. If the adult patient is anxious, consider treating as respiratory distress
  10. If the patient appears dehydrated
    1. Encourage PO fluid intake if patient is able to swallow
    2. If available, offer ice chips and swabs soaked in ice water
    3. Consider administration of normal saline at 10 to 20 mL/kg IV
  11. In collaboration with hospice or palliative care provider, coordinate with guardian, power of attorney, or other accepted healthcare proxy if non-transport is considered

Notes – End-of-Life Care/Palliative Care