LAST HOURS OF LIVING
Managing the Dying Process Joint Position Fatigue • Passive range of motion q30–60 min Skin Care • Hygiene / keep dry • Pressure relieving mattress • Turn q30–60 min • Massage Oral Care • Maintain oral hygiene / moisture • Ice chips if tolerated • Moisten mouth q15–30 min with
Dyspnea • Morphine 5 mg PO q1H PRN or 2 mg SC q30min or 2 mg IV q15min PRN • If multiple PRN doses required, provide routine morphine every t ½ e.g., q4H • Adjust for clearance concerns as noted for pain • For refractory dyspnea • Lorazepam 1‒2 mg PO q1H PRN against buccal mucosa or SC q30min or IV q15min PRN
Oral / Tracheal Secretions • Glycopyrrolate 0.1–0.4 mg or Scopolamine 0.1–0.4 mg IV or SC q8H • Scopolamine patch 1 or more q72H Pain
• Continue analgesics as before • Adjust for clearance concerns • For morphine or other water-soluble opioids that are passively cleared in urine • If urine output < 500 mL / 24 hr, decrease routine dose by at least 50% • If urine output < 250 mL / 24 hr, stop routine dosing
then maintenance dosing q12H, or • Midazolam 1‒2 mg IV q15min PRN, then maintenance dosing by infusion
Baking Soda Mouthwash • 5 mL / tsp baking soda • 5 mL tsp salt • 1 L / quart of water Lips / Nares Care
Terminal Delirium, Hyperactive or Hypoactive if Appears Distressing
• Lorazepam 1‒2 mg PO q1H PRN against buccal mucosa or SC q30min or IV q15min PRN then maintenance dosing q12H, or • Midazolam 1‒2 mg IV q15min PRN, then provide maintenance by infusion
• Coat with Vaseline or petroleum- based product, e.g., lip balm q4H Eye Care • Ophthalmic lubricant q4H
40 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024
T O C
Made with FlippingBook interactive PDF creator