Thank you to everyone who attended January’s webinar Managing Symptoms in Hospice and Palliative Care. We appreciate your insightful and thoughtful questions. For those of you who missed it, here’s a selection from our recent Q&A.
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Is it common practice for most hospices to do wound care?
Yes, wound care is a common practice in hospice settings. Hospice teams often provide wound care to manage symptoms, prevent infections, and ensure patient comfort. This includes care for pressure ulcers, surgical wounds, and other skin conditions that may arise during end-of-life care.
Related: Certified Wound Care Nurse Exam Prep Online Course
Do you recommend a certification in hospice and palliative care for an RN entering this field?
Absolutely. A certification in hospice and palliative care, such as the Certified Hospice and Palliative Nurse (CHPN) credential, is highly recommended. It demonstrates expertise, enhances credibility, and provides specialized knowledge to deliver high-quality care to patients and families.
Have you had experience with the Kennedy Terminal Ulcer (KTU)?
The Kennedy Terminal Ulcer is a skin breakdown that occurs as part of the dying process. It is often unavoidable and signifies multi-organ failure. Hospice teams are familiar with KTUs and focus on comfort measures, such as keeping the area clean, dry, and free from pressure, while educating families about its natural occurrence.
A recent event occurred in which caregivers were neglectful and caused harm. What do you recommend in this situation?
In cases of neglect, it is critical to report the incident to the appropriate authorities, such as the hospice administration or state regulatory bodies. Conduct a thorough investigation, provide additional training to caregivers, and implement stricter oversight to prevent future occurrences. Open communication with the affected family is also essential to rebuild trust.
How can providers educate families about hospice and palliative care services?
Healthcare providers can educate families about hospice services via various methods. Initial orientation sessions can explain the services and goals of hospice care, providing a clear understanding of what to expect. Written materials and brochures tailored to their specific needs can serve as helpful references. Regular family meetings with the care team offer opportunities to address questions and concerns directly.
Additionally, access to online resources or workshops about end-of-life care can provide further insights and support. Encouraging open dialogue is essential to clarify any misconceptions and ensure families feel informed and supported throughout the process.
Pain management and medication in hospice and palliative care
What is the usual dosage for ketamine?
Ketamine dosages vary depending on the condition being treated. For pain management in hospice and palliative care, low-dose infusions (0.1-0.5 mg/kg/hour) are commonly used. Always follow a physician’s prescription and adjust based on patient response.
Related: Managing Symptoms in Hospice and Palliative Care
How is ketamine given?
Ketamine can be administered intravenously (IV), intramuscularly (IM), orally, or subcutaneously. In hospice care, providers often prefer IV or subcutaneous routes for controlled and effective pain relief.
For the Uncle Mel Case Study, why not use a PCA pump in his care?
PCA (Patient-Controlled Analgesia) pumps may not be ideal in hospice care if the patient lacks the cognitive or physical ability to operate the device. Additionally, hospice care often focuses on simplifying medication delivery to ensure comfort without requiring active patient participation.
Are PCA pumps used often in home care?
PCA pumps are less common in home hospice care due to the complexity of setup and monitoring. Instead, medications are typically administered via oral, subcutaneous, or continuous infusion methods to ensure ease of use for caregivers and patients.
Are there any alternative therapies commonly used alongside medications like ketamine in hospice care?
Providers often use alternative therapies alongside medications like ketamine in hospice care to enhance patient comfort and well-being. Massage therapy can help reduce pain and anxiety, providing a soothing and calming effect. Acupuncture is another option, offering pain relief through the stimulation of specific points on the body. Aromatherapy, using essential oils, promotes relaxation and can create a peaceful environment.
Music therapy is also beneficial, as it improves emotional well-being and helps patients cope with stress. Additionally, use guided imagery or meditation to manage pain perception, allowing patients to focus on positive and calming thoughts.
These therapies work in harmony with medical treatments to address both physical and emotional needs in hospice care.
What are the potential side effects of ketamine when used for pain management?
It is important to closely monitor patients on ketamine to manage side effects effectively. Potential side effects of ketamine include:
- Dizziness and drowsiness
- Nausea and vomiting
- Hallucinations or vivid dreams
- Increased heart rate and blood pressure
- Respiratory depression (rare at low doses)
- Cognitive disturbances, such as confusion or disorientation
