Which approach to controlling pain, nausea, and dyspnea should the nurse use for pharmacological management at the end of a patient's life?

Question

1. Administer medication based only on the severity of symptoms that are observed in the patient.
2. Administer prophylactic medication aggressively as symptoms arise to maintain comfort.
3. Administer medications only at the family's request as the patient's health care proxy.
4. Withhold all medication when other therapies are withheld.

Answer 1

2
Rationale 1: The severity of symptoms may not be clearly observed because pain and nausea are subjective symptoms, which are normally reported by the patient and not objectively observed by the nurse.
Rationale 2: Medication should be given aggressively to control and minimize symptoms. Prophylactic doses should be given to minimize the peaks and troughs of blood levels.
Rationale 3: The family cannot act as a proxy for medication needs. They can only express the patient's wishes, but it is nursing judgment that decides medical management.
Rationale 4: Comfort at the end of life is the goal for the health care staff. Pain medication and other medical therapies are not withheld when other therapies are withdrawn. Often the doses are continually increased to maintain the comfort until the end.