Day in the Life of a Hospice, Palliative Care Nurse

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Outline

Overview

  1. Things to Consider
    1. Visiting client homes
    2. Handling death

Nursing Points

General

  1. Key Skills for a hospice/palliative care nurse
    1. Good understanding of pain management
    2. Therapeutic communication
  2. Typical daily routine
    1. Visiting your assigned patients in a facility, their homes, or if you have hospice care on your unit
    2. Management of pain is HUGE!
    3. Try to accommodate any patient wishes
    4. Support the family
  3. Challenges
    1. You will get attached to patients and families and then lose them
    2. You will deal with death
    3. Family disagreements
    4. Can be draining

Assessment

  1. Things won’t be with in normal limits
  2. Regular head to toe assessment with a focus on:
    1. Pain
    2. Skin integrity

Therapeutic Management

  1. Comfort
  2. Pain management

Patient Education

  1. Process
  2. Pain control

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Transcript

Hey guys, I want to take you through what it’s like to be hospice or palliative care nurse. So first let me tell you that I did hospice nursing as a new nurse and I loved it, but there were some things that were very hard. So the first thing I’ll let you know is that you have to go into people’s houses and be okay with that. I did my hospice rotation was on a med search floor and I was tired of doing med search and I did not want to go into people’s houses, so I had to give up doing hospice nursing. So yes, you will go into people’s homes. It can be in their facility home where they are, or you could work in a unit that has hospice beds and then the obvious you’re dealing with death, but you need to consider this, is that gonna be okay for you.

You know, some nurses are awesome at it, they’re meant to do it, and then others that can only handle so much of it. So just keep that in mind. So some other pieces here, some skills. So you have to be really good at helping with pain management and kind of anticipating that the dying process can be very painful. And so these patients are given a lot of morphine typically, just sublingual given to them to help with that pain. Even if they don’t look to be in too much pain, sometimes it’s good to just to give it and anticipate that and take care of it instead of trying to fix it afterward. Then therapeutic communication. So a lot of times these patients, they’re gonna end up, you know, they’re comatose, they’re not able to talk, they’re just laying there pretty much asleep, but you are going to be dealing with the families a lot, so you need to be really good at communication and talking and just knowing that you don’t always have to respond sometimes just listening to them. I always felt like therapeutic communication was so difficult to master, but just being there and listening to them sometimes it’s all they need.

So a typical day. You are going to be visiting your assigned patients in their home or their facility. Or sometimes if they’re in the hospital, sometimes families have a difficult time when that gets closer, that they don’t want them to die at the house. They take them to a hospital or some place else. So wherever your patients are, you’re going to be busy visiting them. Or if you work on a medsurg floor then you’re gonna just be incorporating them into your normal day, seeing them, you’re going to manage their pain. So whatever they need. Like I said, a lot of times we’re doing morphine. Some might have a pump that’s helping to give them some extra medication depending on what’s going on. So you will be doing huge assessments, talking with the families and making sure that their pain control is, is okay, uh, accommodate wishes and needs. They’re dying so let them have what they want. If they’re awake and want to eat some ice cream and let them have some ice cream. We had a patient on the medsurg floor that I was on that really missed him dog and we snuck the little puppy dog up. Wasn’t a puppy, but it was this small dog up the back stairs and let that dog lay in the bed with that man that night and he loved it. So just to accommodate their wishes and needs, whatever you can do, support the family. So that’s huge. Uh, you have to be a huge support system. Just listen.

So some challenges you will a hundred percent get attached to these patients, um, and attached to the families. So that can be very challenging because they’re going to die and you will not be seeing this family all the time seeing as patient and that’s really difficult. I had some amazing patients that I will never forget and then you’re going to deal with death. So it’s inevitable. People think like, okay, I can do it. It gets to be really draining. I’m really draining. So just know that family disagreements, okay, so this happens a lot, right? They’re fighting over who’s getting the China, they’re fighting over money. Maybe one doesn’t think that hospice is what’s needed and another sibling does. Things like that. And when the stress level rises, these disagreements can really happen. And then, like I said before, just super draining. So just be prepared for that.

All right guys, to some key points, like you’ve heard me say it’s draining, but I will tell you it’s rewarding. I made amazing connections with these families and I would not give that up for anything. I hope you guys have a better understanding of what hospice, nursing and palliative nursing is all about.

We love you guys now go out and be your best selves today, and as always, happy nursing.

 

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Mental Health Prep

Concepts Covered:

  • Studying
  • Substance Abuse Disorders
  • Anxiety Disorders
  • Central Nervous System Disorders – Brain
  • Cognitive Disorders
  • Eating Disorders
  • Medication Administration
  • Depressive Disorders
  • Personality Disorders
  • Psychotic Disorders
  • Trauma-Stress Disorders
  • Bipolar Disorders
  • Developmental Considerations
  • Concepts of Mental Health
  • Health & Stress
  • Psychological Emergencies
  • Somatoform Disorders
  • Communication

Study Plan Lessons

08.01 Psychological Review for CCRN Review
Addiction – Behavioral Problems Nursing Mnemonic (The 5 D’s)
Albumin Lab Values
Alcohol Withdrawal (Addiction)
Alcohol Withdrawal Case Study (45 min)
Alcoholism – Outcomes Nursing Mnemonic (BAD)
Alprazolam (Xanax) Nursing Considerations
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Alzheimer – Diagnosis Nursing Mnemonic (The 5 A’s)
Ammonia (NH3) Lab Values
Anorexia – Signs and Symptoms Nursing Mnemonic (ANOREXIA)
Antianxiety Meds
Antianxiety Meds
Antidepressants
Antidepressants
Antipsychotics
Antipsychotics
Anxiety
Anxiety Disorders (PTSD, Anxiety, Panic Attack) for Certified Emergency Nursing (CEN)
Atypical Antipsychotics
Benzodiazepines
Benzodiazepines Nursing Mnemonic (Donuts and TLC)
Blood Urea Nitrogen (BUN) Lab Values
Bulimia – Signs and Symptoms 1 Nursing Mnemonic (BULIMIA)
Bulimia – Signs and Symptoms 2 Nursing Mnemonic (WASHED)
Buspirone (Buspar) Nursing Considerations
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Carbamazepine (Tegretol) Nursing Considerations
Chloride-Cl (Hyperchloremia, Hypochloremia)
Chlorpromazine (Thorazine) Nursing Considerations
Cholesterol (Chol) Lab Values
Cognitive Impairment Disorders
Creatinine (Cr) Lab Values
Day in the Life of a Hospice, Palliative Care Nurse
Day in the Life of a Mental Health Nurse
Defense Mechanisms
Defense Mechanisms
Dementia Nursing Mnemonic (DEMENTIA)
Depression
Depression Assessment Nursing Mnemonic (SIGNS)
Depression Concept Map
Diazepam (Valium) Nursing Considerations
Disruptive Behaviors, Aggression, Violence for Progressive Care Certified Nurse (PCCN)
Dissociative Disorders
Divalproex (Depakote) Nursing Considerations
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Encephalopathy Case Study (45 min)
End of Life for Progressive Care Certified Nurse (PCCN)
End-of-Life and Palliative Care (Organ and Tissue Donation, Advance Directives, Care Withholding, Family Presence) for Certified Emergency Nursing (CEN)
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Generalized Anxiety Disorder
Glomerular Filtration Rate (GFR)
Grief and Loss
Grief and Loss
Haloperidol (Haldol) Nursing Considerations
Handling Death and Dying
Head to Toe Nursing Assessment (Physical Exam)
Homicidal and Suicidal Ideation for Certified Emergency Nursing (CEN)
Hypochondriasis (Hypochondriac)
Lamotrigine (Lamictal) Nursing Considerations
Lithium (Lithonate) Nursing Considerations
Lithium Lab Values
Liver Function Tests
Lorazepam (Ativan) Nursing Considerations
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
MAOIs
Meds for Alzheimers
Mental Health Course Introduction
Metabolic Alkalosis
Methadone (Methadose) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Mood Disorders (Bipolar, Depression) for Certified Emergency Nursing (CEN)
Mood Disorders (Bipolar)
Mood Stabilizers
Mood Stabilizers
Nurse-Patient Relationship
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Depression
Nursing Care Plan (NCP) for Dissociative Disorders
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Paranoid Disorders
Nursing Care Plan (NCP) for Personality Disorders
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Suicidal Behavior Disorder
Nursing Case Study for (PTSD) Post Traumatic Stress Disorder
Nursing Case Study for Bipolar Disorder
Nursing Case Study for Mania (Manic Syndrome)
Olanzapine (Zyprexa) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
Palliative Care for Progressive Care Certified Nurse (PCCN)
Paranoid Disorders
Paroxetine (Paxil) Nursing Considerations
Personality Disorders
Phases of Nurse-Client Relationship
Phosphorus-Phos
Post-Traumatic Stress Disorder (PTSD)
Postmortem Care
Potassium-K (Hyperkalemia, Hypokalemia)
Psychological Disorders (Anxiety, Depression) for Progressive Care Certified Nurse (PCCN)
Quetiapine (Seroquel) Nursing Considerations
Schizophrenia
Schizophrenia Case Study (45 min)
Self Concept
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Sertraline (Zoloft) Nursing Considerations
Sodium-Na (Hypernatremia, Hyponatremia)
Somatoform
Somatoform Disorder Case Study (30 min)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
SSRIs
Substance Abuse (Alcohol, Drug Withdrawal) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Chronic Alcohol Abuse, Chronic Drug Abuse) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Drug-Seeking Behavior) for Progressive Care Certified Nurse (PCCN)
Suicidal Behavior
TCAs
Therapeutic Communication
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Thought Disorders (Psychosis, Schizophrenia) for Certified Emergency Nursing (CEN)
Total Bilirubin (T. Billi) Lab Values
Types of Schizophrenia
Urinalysis (UA)
Vitamin B12 Lab Values