Insights

Insights is a monthly publication focused on influencing quality End-of-Life care

Hospice provides many services to its patients and their families, but it is probably known best for its expertise in pain and symptom management. True, hospice nurses often eliminate pain and symptoms everyone thinks are insurmountable, but hospice nurses are not the only people with the ability to eliminate, or lessen, symptoms. Anyone on the care team can provide some very simple care to ease the suffering of an individual who is dying, such as:

General

· Apply cold compresses (wash cloth) to the bridge of the nose and eyes.

· Gently put a pillow under the knees of an individual who is lying on their back (this eases the strain on the back, making the person more comfortable).

· Gently massage the patient’s hands and wrists.

Dry mouth/tongue

· As long as the patient can swallow, give water frequently.

· Give water-soaked gauze or gauze filled with ice chips for the patient to suck on.

· Assist with mouth care.

· Assist patient to rinse mouth frequently.

Stomatitis (sore mouth)

· Assist the patient to rinse mouth as directed.

· Provide soft, bland food—avoid hot, spicy rough-textured or acidic food.

· Serve food lukewarm rather than hot or cold.

Dysphagia (difficult swallowing)

· Position patient in the bed as directed (always with the head of the bed up).

· Give only foods as directed—soft foods and solids may be easier to swallow than liquids (such as ice cream, pudding, or applesauce).

Nausea and Vomiting

· Assist with appropriate mouth care.

· Encourage patient to rest after meals.

· Provide diversion for the patient.

Constipation

· Remind patient to take medications.

· Encourage fluids.

· Assist with exercise/activities.

Diarrhea

· Encourage fluids.

· Notify nursing staff so they can follow up with medication, if necessary.

Mucus in the throat

· Give carbonated beverages.

· Encourage coughing and deep breathing.

· Avoid giving ice cream.

Cough

· Assist to keep throat moist—sips of water, hard candy, throat lozenges.

Shortness of Breath

· Assist patient to pace activities—use oxygen (if prescribed) 15-20 minutes before planned activities or a meal.

· Assist patient using relaxation techniques (music, life review, imagery).

· Place a fan in appropriate location for air movement.

· Encourage coughing and deep breathing (keep tissue and trash can within patient’s reach).

· Do not leave when the patient dozes off unless you specifically tell them “I will sit with you until you doze off”.

· Re-orient to time, person, place as needed (do not argue with patient and accept what they say as real to them).

· Massage lotion or oil into skin (only on closed skin), especially on hands and face.

Factors 1 and 2 must be present; factors from 3 will add supporting documentation:

1. CD4+ count < 25 cells/mcL or persistent viral load >100,000 copies/ml, plus one of the following:

* Untreated, or not responsive to treatment, wasting (loss of 35% lean body mass).

* Mycobacterium avium complex (MAC) bacterium, untreated, unresponsive to treatment, or treatment

* Systemic lymphoma, with an advanced HIV disease and partial response to chemotherapy.

2. Decreased performance status, as measured by the Karnofsky Performance Status (KPS) scale, of ≤ 50% .

3. Documentation of the following factors will support eligibility determination:

* Absence of antiretroviral, chemotherapeutic and prophylactic drug therapy related to HIV disease;