What is a Comfort Pack in Hospice? How to Manage Symptoms.


When managing unpleasant symptoms in hospice, there are a few medications that are used most commonly.

In palliative care, for someone who is suffering from a serious disease or illness, the priority is to provide comfort by managing the patient’s symptoms.  This is in opposition to an aggressive treatment approach, when the physician’s primary focus is on managing the disease or illness.  In hospice, we continue treat the disease or illness conservatively, but it usually understood that the underlying issues cannot be fixed.   Therefore addressing these unwanted symptoms experienced by hospice patients is the key to improving their quality of life.

The term “Symptom Management” is used frequently by hospice providers. Symptoms are mental and physical conditions that are
the byproduct of a serious disease or illness.  Another term that is used to define a palliative approach to treating symptoms is “Comfort Care”.  When someone is new to hospice, the doctor will typically order a set of medications that are intended to relieve symptoms, referred to a “Comfort Pack”.  The actual medications that are ordered vary slightly, depending on the hospice agency.

A comfort pack is an essential tool kit for the hospice nurse, and can prevent an unnecessary trip to the emergency room.

When a person is in serious pain or unable to breath, they will need immediate attention.  Those two symptoms are often deal breakers.  More often than not, the patients or their loved ones will call 911 in those situations.  Who could blame them, if they did not have what they needed to help their loved one?  It is the responsibility of the hospice nurse to make sure that patient and their loved ones  have what they need, in order for them to be prepared for the unexpected situations.  Hospice agencies have a nurse accessible to you for guidance, 24 hours a day.  If you or your loved are having difficulty managing symptoms, there should always be a nurse available to respond with a home visit, within an hour of placing the call.  There are times when your hospice physician will request that you go to emergency room, after the hospice nurse has assessed the situation.  This would be dependent on an individual’s unique circumstance.

It is my hope that patients and their caregivers will feel comfortable and confident, and be capable of administering medications, when it is appropriate.  It is imperative that everyone is involved in the decision making process, and my role as a hospice nurse is to provide guidance on how you can best care for your loved one.

 

These are the common medications that are found in a comfort pack, and used to manage various disease related symptoms.

PAIN

Pain management is a broad and complex subject, and there are many medications to treat this symptom.  In the comfort pack, Morphine is an Opiate medication that is most commonly prescribed in the form of Roxanol. This is a type  Morphine comes in a liquid form, and it can be given under the tongue in small amounts.  This medication is very effective, and works very quickly.

SHORTNESS OF BREATH

  • Roxanol aka Morphine

  • Lorazepam aka Ativan

The symptom of shortness of breath refers to someone who is experience a  feeling  of “air hunger”,  and they are breathing at a faster rate than normal.  The nurse will count how many breathes someone will fully inhale and exhale during the course of a full minute, and this is called a respiratory rate.  When someone is breathing more than 40 breathes in a minute, this is considered respiratory distress, and can be uncomfortable.  Both Roxanol and Lorazepam will help in relieving shortness of breath, as they both work to relax the chest muscles and slow down the respiratory rate.

NAUSEA AND VOMITING

  • Zofran ODT aka Ondansetron

  • Phenergan aka Promethazine

When approaching symptoms of Nausea, there are several medications that are known to be effective.  Zofran is commonly used in cancer patients, and is in a tablet that dissolves under the tongue.  Phenergan can be used for more persistent nausea, and can be administered in suppository form in the rectum.  Sometimes this is a preferred route of administration, especially when someone may be actively vomiting.  Both of these medications may cause some drowsiness, which seems to be more evident with the use of Phenergan.

FEVER

  • Tylenol aka Acetaminophen

Fevers are not uncommon in the hospice patient.  Often times fever can be associated with nausea, vomiting, or impaired ability to swallow.  Tylenol is an over the counter medication that can be administered in a suppository form, and it is very effective in lowering body temperature.

CONSTIPATION

  • Dulcolax aka Bisacodyl

Every hospice patient will need a bowel regimen to address and prevent constipation.  This is a very common symptom that is often caused by lack of physical activity, difficulty tolerating fluids, and as a side effect of other medications.  The comfort pack will usually include a stimulant laxative for use typically after three days without a bowel movement.  Dulcolax can be given in suppository form and is very effective treating constipation without causing diarrhea.

ANXIETY

  • Lorazepam aka Ativan

Many hospice patients  suffer from anxiety, and this is one of more under-treated symptoms in hospice.  There are many reasons why anxiety would be present,  but often times can be related to fears of death and dying.  Anxiety should be addressed by the entire hospice team, as there may be spiritual or psychosocial factors that are contributing to and worsening these symptoms.

RESTLESSNESS

  • ABH Gel aka Ativan-Benadryl-Haldol Compound

It is not uncommon as the end of life approaches, a hospice patient can experience some episodes of extreme inability to relax.  Sometimes you or loved one may behave in ways that are out of character, with the potential to even become agitated and aggressive.  This medication is a topical gel that can be applied by the caregiver, in an effort to manage these types of symptoms.

RESPIRATORY CONGESTION

  • Atropine Sulfate

  • Levsin aka Hyoscyamine

There is a type of cough and congestion that is specific to the end of life, and these medications may help provide some relief.  In hospice, we refer to this type of congestion as respiratory secretions.  The intent of Atropine is ease breathing,  by reducing the amount of secretions that may be occurring.  Your hospice nurse with guide you on how to use these medications, and when this may be an appropriate intervention.

These are generally the medications you will find in a Comfort Pack, but there are many other medications that the  hospice doctor may prescribe to manage symptoms.  Your hospice nurse will work very closely with you and your doctor, with a common goal to provide comfort and improve quality of life.

I hope you found this information useful. Please feel free to ask a question or leave a comment.




10 Comments

  • diljithmn May 1, 2017 at 2:26 am

    Hi Heather. Thank you so much for your blog post about these medications. I like your website about hospice care, especially the Video ‘what is hospice care’ is helps me to easily understand about hospice. I’m very happy to meet you here.Do you know Dr Ray D Strand? I read his book. I liked him so much. I wish you all the best .

    Reply
    • Heather Williams RN CHPN May 1, 2017 at 2:41 am

      Thank you for taking the time. I am familiar with Dr. Strand’s work with nutritional medicine, it is very interesting.
      Take Care,
      Heather

      Reply
  • S McFadden May 1, 2017 at 2:27 am

    Thanks for the excellent information. It’s important for families to understand that the quality of a loved one’s life can be improved tremendously by treating the symptoms of their illness and declining health.

    Reply
  • jeffrey16201 May 1, 2017 at 3:42 am

    Very interesting article, I never knew hospice nurses carried emergency comfort packs before now. That is very useful for the patients and the nurse, it a comfort to know this for people who depend on their hospice nurse to provide care for them to be prepared for an emergency with this type of pack.

    Reply
    • Heather Williams RN CHPN May 1, 2017 at 3:54 am

      Hi Jeff,
      Thank your for comment. I am glad that you mentioned about how these kits are received by the patient. We use specialized pharmacies that are able compound medications. The pharmacy delivers the medications to the patient’s home once they are ordered by the physician, and it requires a signature of receipt. But is hospice is always ready to respond if a patient is in need.
      Take Care,
      Heather

      Reply
  • wongskcom May 1, 2017 at 10:58 am

    My mom is in hospice right now, and we did get the same medications that you were discussing in your post. Thank you so much for clearing up what all these medications are and there intended purpose. They dropped them off last week, but no one really told me what they were. I appreciate it.

    Reply
    • Heather Williams RN CHPN May 3, 2017 at 11:32 am

      I am glad that you found the information useful. Your hospice nurse will be guiding you and your family on how to use these medications too and when they might be appropriate.
      Take Care,
      Heather

      Reply
  • Israel May 1, 2017 at 12:13 pm

    Hi Heather!

    As you first pointed out, the most important thing, in cases of serious diseases is to make sure the person has a much quality of life as possible.

    I’ve lost several people in my family, and it’s really helpful to know how to relieve the pain and suffering in those critical moments.

    Thanks for the article! It really needs to be read.

    Reply
    • Heather Williams RN CHPN May 3, 2017 at 11:40 am

      Thank you for taking the time, I am glad that this information was helpful to you.
      Take Care,
      Heather

      Reply

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