Palliative Comfort measures

Palliative Comfort measures
-Diagnosis: [text size=“100"]
-Other Diagnoses: [text size="50”]

-Goals of Care changed to Code: [select name="codestatus1" value="C1|C2"][conditional field="codestatus1" condition="(codestatus1).is('other-')"][text size="50"][/conditional].
-Goals of care and comfort measures discussed with: [comment memo="List who was involved" memo_size="small"][checkbox value="Patient|Spouse|Son|Daughter|ADM|Public-Guardian|Sister|Brother|Parents|Family"][text size="80”].

-Discontinue previously scheduled lab and diagnostic investigations.
-Cancel previously scheduled appointments.
-Insert indwelling Foley catheter only as needed for urinary retention or patient comfort using 2% Lidocaine gel.
-Insert subcutaneous catheter only as needed for administration of s.c medications.
-Activity as tolerated.
-Discontinue vital signs including oximetry.
-If symptoms are not well managed with current care and medication notify MD.
[comment memo="If has an ICD" memo_size="small"][checkbox value="Deactivate Implantable Cardiac Defibrillator as discussed with|the patient|and or |the ADM|Consult Pacemaker Clinic for this|no longer requiring IV narcotics for pain control|pain adequately improved/improving|may require ALC placement upon discharge"][text size="80”].

-Diet:
[checkbox value="Regular as tolerated for comfort as discussed with patient ADM for potential aspiration risk|Current dietary preferences|sips of water for confort"].

-Hydration:
[checkbox value="Oral fluids and ice chips as tolerated for comfort as discussed with patient ADM for potential aspiration risk|0.9% NS hypodermoclysis infusion at"][select name="mlshr1" value="30|40|50"][conditional field="mlshr1" condition="(mlshr1).is('other-')"][text size="50"][/conditional]mls/hr.

-Respiratory Care:
[checkbox value="O2 not required|O2 for comfort by Nasal Canula at 4L per min|Secaris nasal gel q4h PRN for dry nares"].

-For Comfort:
[checkbox value="artificial saliva gel topically to oral mucous membranes QID for dry mouth|artificial saliva gel topically to oral mucous membranes q 1h PRN for dry mouth|Hydroxypropylmethylcellulose 0.5% artificial tears eye drops 1 drop to each eye q1h PRN while awake for dry eyes|Tylenol 650 mg supp rectally q4h prn for symptomatic fever or mild discomfort"].

-For Pain and or Dyspnea:
[checkbox value="Hydromorphone 0.5 mg sc q  1h PRN If patient receives more than 3 doses in 8 hours contact MD to adjust dose|Hydromorphone 0.5 mg sc q6h ATC|Morphine 2.5 mg sc q1h PRN and If patient receives more than 3 doses in 8 hours contact MD to adjust dose|Morphine 2.5 mg sc q6h ATC"].

-For Agitation Nausea and or Vomiting:
[checkbox value="Haloperidol 1 mg sc q1h PRN and If ineffective after 3 consecutive doses OR if patient receives more than 3 doses for Nausea Vomiting and or agitation in 8 hours contact MD|If Extreme agitation Nozinan 12.5 mg sc q 1h PRN and if ineffective after 3 consecutive doses contact MD"].

-For Nausea and or Vomiting:
[checkbox value="Metoclopramide 10 mg sc q8h|Metoclopramide 10 mg sc q1h PRN and If patient receives more than 3 doses in 8 hrs contact MD|see Haloperidol option above"].

-For Distressing Respiratory secretions:
[checkbox value="Review NS Clysis with patient ADM and MD|Glycopyrrolate 0.4 mg sc q1h PRN|OR scopolamine hydrobromide 0.4 mg sc q1h PRN"].

-Urgent Symptoms:
[checkbox value="Midazolam 5mg sc one dose PRN AND may repeat q 5 Minutes PRN for refractory seizures lasting more than 2 minutes and or for massive distressing hemorrhage|If ineffective after 3 consecutive doses contact MD"].

-Referrals - consult Palliative care:
[checkbox value="For symptom management and support|For Hospice bed"]
 
[checkbox value="Discontinue the following medications"]