Need for Doctor's Order for Medications: All medications given must be approved by the Attending Physician. No other medication or treatment should be given to your loved one without notifying the hospice RN case manager. This is important so that all efforts to maintain patient comfort can be coordinated by the RN. Any medications started by the nurse by use of Standing Orders have already been approved by the Attending Physician for specific situations, and the physician will be notified of any standing order medications begun.
Ways of Giving Medications: Medications are taken in different ways or routes of administration. The different ways are chosen by the physician according to which manner will be most effective. During the course of your loved one's illness, the methods will change. Swallowing pills may be the easiest way to take medicine in the beginning, but after some time, it is possible that swallowing will become difficult or impossible.
Problems with absorption and Ways of Giving Medications: Another reason for changing routes of administration are problems with absorption. For example, if your loved one has a disease affecting the digestive system, the oral route may not be ideal. If the liver is affected, medications may not be properly metabolized or processed from the digestive system, interfering with absorption. If the circulation is affected, injections may not be effective in the legs or arms, but may be effective given intravenously. If the patient is having much fluid buildup in the lungs due to lung or heart disease, it may not be appropriate to give medications by mouth, or even sublingually by drops. These are only some of the considerations the physician and RN case manager will be monitoring when thinking about the medications being given.
Common Abbreviations Used in Doctor's Orders: If you will be responsible for giving medications or treatments to your loved one, the hospice RN case manager will instruct you on which medications the physician has ordered, when and how to give them. There may be a medical chart or sheet for recording when medications are given. In order to help you understand some of the more common abbreviations used on these medication sheets, the following abbreviations are shown here:
If the physician has ordered medications to be given by injection, by use of a patch or suppository, or by any other means, the hospice nursing staff will explain and demonstrate to you how to give these medications. If you have any questions or difficulties, the hospice will have a nurse available by phone to answer questions. If needed, another on-call nurse must be available to come out and assist you with difficulties.
Crushing Medications & Giving Medications Under the Tongue: There may come a time when your loved one will be unable to swallow pills. If this occurs, the physician must be notified and asked for guidance. The physician may order pills to be crushed and given with applesauce if your loved one can swallow that mixture. If that is not possible, pills that are crushed can be mixed with very small amounts of water, let dissolve and then given drop by drop with a dropper or oral syringe. Certain medications available in table or capsule form may not be able to be crushed or opened to be given in this way. In those cases, the physician may order another comparable medication that can be crushed, or he may order a different form of the same medication, perhaps a liquid form or injectable form.
Your RN case manager will explain the physician's orders and how to crush the medications. Two spoons can be used to crush a pill in between them, a mortar and pestle may be used, or you can purchase a pill crusher at your local pharmacy. The drops may sometimes be placed in the area inside the mouth against the cheek or under the tongue depending upon the instructions of your physician. Giving medications by drop under the tongue encourages the medication to be absorbed directly within the mouth and not through the digestive system.
Dealing With Drying of the Mouth: As death approaches very closely, many persons begin to breathe mainly through their mouth. The mouth is left open at all times and begins to dry out. There may be a red tongue with cracks in certain cases, which can be quite uncomfortable. Some family members apply a small amount of olive oil (or other vegetable oil) with a cotton tip applicator to the tongue and lips, which can help your loved one to be more comfortable. Applying vaseline or mineral oil is not recommended for the inside of the mouth.
Although many people attempt to moisten their loved one's mouth with water, there comes a time when he will be unable to swallow, and providing water will cause coughing and choking. For this reason, the olive oil may be preferable. There are also forms of artificial saliva which may be ordered by the physician to deal with this problem, (but even the "artificial saliva" dries up).
More information about prescriptions and the laws governing prescriptions of medications can be found at the Drug Enforcement Administration and prescriptions: https://www.dea.gov/. If you have questions about hospice, we hope that you will take the time to visit the hundreds of pages at our website, read our Guide to Hospice Care, visit our resources and links section (with hundreds of vital resources listed).
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inherently valuable and that the role of hospice nurses,
physicians and all other staff is to alleviate suffering and
provide comfort for the sick and dying without sanctioning or
assisting their suicide. A death with dignity allows for a
natural death in its own time, while doing everything possible to
assure relief from distressing symptoms. Hospice Patients
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