Jacqueline R. Reviel
Loyola University New Orleans
End of Life Peace without Pain
Pain management during end of life care is crucial to the comfort and peace of the patient and their family. “With better pain control, dying patients live longer and better. Pain shortens life. Relief of pain extends life” (Zerwekh et al., 2006, p.317). The nurse must educate about (a) disease pathology, (b) signs & symptoms, (c) interventions, (d) medications, (e) alternative therapies, and (f) supportive care, related to end of life care. Pain management involves understanding the pharmacological issues, and management issues surrounding opioid drugs used for pain control. The identification of (a) nursing diagnosis, (b) implementation, and (c) education are essential in keeping the patient and family comfortable and at peace. Pathology, Signs and Symptoms
End of life presents with specific pathology which can cause extreme pain and discomfort. The body’s organs begin to shut down as death approaches hypoventilation causes hypoxemia and hypercapnia in turn increasing the workload of the heart as it tries to oxygenate the vital organs. The kidneys and liver begin to fail and toxins begin to build up. The heart fails as it can’t keep up with the demand. Zerwekh (2006) lists specific signs and symptoms associated with death (a) reduced level of consciousness, (b) taking no fluids or only sips, (c) decreased urine output, (d) progressing coldness and mottling in legs and arms, (e) irregular labored breathing; periods of no breathing, and (f) the death rattle. Diagnosis & Interventions
Diagnoses related to end of life care are (a) Ineffective tissue perfusion, (b) Alteration in comfort, (c) Activity intolerance, (d) Impaired gas exchange; (e) Ineffective breathing patterns, and (f) Decreased cardiac output. Interventions are attached to each diagnosis and a plan of care is established for the patient. Interventions for alternation in comfort include (a) spiritual, (b) pharmacological, and (c) alternative methods. Ineffective tissue perfusion involves (a) positioning, (b) O2, and (c) fluid management. Activity intolerance is managed by pacing periods of activity with rest. Impaired gas exchange is managed by decreasing fluid shifts with medication. Ineffective airway clearance is helped by (a) positioning and (b) suctioning to clear the airway. Disturbed thought processes interventions are (a) reorient the patient, (b) supporting family, and (c) visitors at times when the patient is most alert. Interventions are tailored specially to the patient’s needs and their disease process. Pain management
“Dying does not need to be painful” (Moynihan et al., 2003 p. 1401). Holistic pain management is crucial during end of life care. Terminally ill patients can have (a) physical, (b) spiritual and (c) emotional pain. Providing comfort is important in decreasing suffering. Emotional pain can be addressed by (a) laughter, (b) memories, and (c) touch. Spiritual pain can be helped with (a) prayer, (b) meditation, (c) talking, (d) listening, (e) pastoral care, and (f) providing the last rights. Physical pain is managed pharmacologically and with alternative comfort measures. Opioids are given to treat severe pain at the end of life. Parlow (2005) used nitrous oxide to control incident pain in terminally ill patients with positive results. Pharmacological issue related to pain management
Pharmacological issues surrounding pain management are (a) issues of addiction under medication, (b) legal repercussions, (c) respiratory effects, and (d) side effects. Zerwekh (2006) sums up the fallacy of addiction by stating persons with addiction take their opioids to escape life, whereas persons with pain take their opioids to live life more fully. These issues and lack of knowledge often cause Physicians to under medicate during end of life care. The nurse needs to have full understanding of how opioids work and how to...