NCLEX-PN · Basic Care and Comfort · 7 min read
Palliative and Postmortem Care
- Distinguish between the indications, settings, and goals of palliative care and hospice care.
- Identify physical signs of impending death and implement comfort-focused nursing interventions within the practical nursing scope.
- Execute standardized postmortem care procedures while maintaining client dignity, adhering to regulatory guidelines, and supporting the family.
Foundations of Palliative and Hospice Care
Palliative care and hospice care share the essential goal of optimizing comfort, yet they differ in their indications, timing, and relationship to disease-directed therapies. Palliative care focuses on relieving symptoms and improving quality of life at any stage of a serious illness. A client receiving palliative care does not need to have an immediate end-stage prognosis, and palliative care can be provided concurrently with curative treatments. For example, a client undergoing curative chemotherapy may receive concurrent palliative care to manage severe pain or nausea.
Hospice care is indicated specifically for clients with a terminal diagnosis, typically with a life expectancy of six months or less. Unlike palliative care, hospice care focuses on comfort and symptom management rather than curative interventions. An eligible client may choose hospice care when the goal of care shifts to comfort; hospice enrollment is not automatic, and some disease-directed treatments may still be used to relieve symptoms.
Within the interprofessional team, the licensed practical/vocational nurse (LPN/VN) performs vital roles under the direction of the registered nurse (RN). The initial comprehensive assessment, formulation of the plan of care, and initial client teaching belong to the RN. The LPN/VN contributes by collecting data on client distress, reinforcing teaching regarding the plan of care, and promptly reporting pain or uncontrolled symptoms to the RN. The LPN/VN checks the record for advance directives and a current DNR order, reports questions or discrepancies to the RN, and follows the plan of care; a DNR order limits resuscitation and does not, by itself, limit other care.
| Care Feature | Palliative Care | Hospice Care |
|---|---|---|
| Target Population | Clients at any stage of a serious illness | Clients with a terminal diagnosis (typically life expectancy of six months or less) |
| Treatment Goal | Relieving symptoms and improving quality of life | Comfort and symptom management |
| Curative Interventions | Can be provided concurrently with curative treatments | Focuses on comfort rather than curative interventions |
| LPN/VN Role | Collects data, reinforces teaching, provides comfort care, and reports to RN | Collects data, reinforces teaching, provides comfort care, and reports to RN |
Common mistakes
- Assuming palliative care cannot be given while a client receives curative treatments. Palliative care can be provided concurrently with curative interventions at any stage of a serious illness.
- Removing lines, tubes, or indwelling catheters when an autopsy or medical examiner investigation is pending. All invasive equipment must remain in place unless authorized personnel direct otherwise.
- Performing aggressive or deep oropharyngeal suctioning to clear the 'death rattle.' Deep suctioning can cause trauma and distress; the nurse should instead position the client, elevate the head of the bed, and administer prescribed anticholinergic medications to reduce new secretions.
- Forcing food or fluids on a dying client who exhibits anorexia or dysphagia, rather than recognizing that decreased intake is a normal physiologic response during the dying process.
Key points
- Palliative care improves quality of life at any stage of serious illness and can occur alongside curative treatments, whereas hospice care focuses on comfort and symptom management for terminal clients typically having a life expectancy of six months or less.
- The LPN/VN collects data on signs of impending death, such as Cheyne-Stokes respirations, the 'death rattle,' mottling, falling blood pressure, sphincter relaxation, and decreased urine output, reporting uncontrolled symptoms to the RN.
- Comfort interventions include elevating the head of the bed or side-lying positioning, frequent oral care with moist swabs, lip lubricant, artificial tears, gentle repositioning, and administering prescribed medications like morphine, bowel regimens, and scopolamine or glycopyrrolate.
- Postmortem care begins promptly after clinician pronouncement to prevent positioning difficulties from rigor mortis, utilizing standard precautions, clean gloves, supine positioning with a slightly elevated head of bed, a pillow under the head, and light pressure to close eyelids.
- Leave lines and drains in place when an autopsy or medical examiner investigation is pending; otherwise, check with the RN for organ or tissue donation requirements before removing devices as directed, within scope and policy, and covering puncture sites.
- The LPN/VN accommodates cultural and religious practices, inventories belongings, applies identification tags to the body, shroud, and property containers, and notifies the RN for required organ procurement organization referrals.
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