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Next Reply: Re:Palliative Sedation Advice
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Post Palliative Sedation Advice
Author: sredding
Date: Jun 18, 2012 6:23 pm
Our palliative care service has been consulted to assist with the care of a woman with paranoid schizophrenia - hospitalized at a psychiatric facility for past ~6 yrs. She now has metastatic adenocarcinoma - probable ovarian - with ascites and SBO. She has historically refused parenteral meds. She has occassionally taken SQ, but with no consistency. We have suggested depot haldol and roxanol 20mg/cc SL for pain control(which she takes at times). We have suggested octreotide but have no reliable way of administering it to her. The primary team contacted us today to inquire about palliative sedation. Any suggestions/thoughts would be appreciated.
Susan
Replies: order by [Date] [Author] [Subject]
+ Re:Palliative Sedation Advice (by hcgmille on 06/20/2012)
susan, this appears to be a perfect case for inpatient GIP care. obstruction managed with SQ or IV meds, octreotide to control nausea and vomiting. palliative sedation probably not needed once symptoms controlled.
Re:Palliative Sedation Advice (by SharolHerr on 06/26/2012)
Responding to a patient's acute symptoms is often complicated by where they are being cared for. Since attempts to manage her symptoms have been unsuccessful in the psychiatric facility, I would suggest transitioning the patient to the acute care hospital with consultation by the acute palliative care service. There are lots of resources and meds that could be implemented there including sedation so that the appropriate treatment plan can be administered. In the midst of her restlessness the pain and discomfort from the SBO could well be a significant contributing factor. It sounds like her psychosis is going to be a major barrier in understanding the plan of care. Although hospital admission isn't the preferred first line it certainly is a welcome alternative when complicated cases such as this present. Sharol Herr, RN, BSN, MSEd, CHPN; Palliative Clinical Manager; Mount Carmel Health Palliative Care Leadership Center; Cols., Ohio.
Re:Palliative Sedation Advice (by sredding on 07/23/2012)
Thanks to both of you for your suggestions. This was a challenge, as the paranoid schizophrenia precluded the administration of some needed meds at times. We had most of everything SL, but transdermal was not an option as long as patient had the energy to pull/rub things off. IV was never an option and SQ was sometimes refused. We did get her symptoms controlled on our palliative care unit and were able to transfer her to a NH near her home, her mother's wish, where she died peacefully last week. The combination of the severe psychiatric illness and the terminal physical illness challenged all of us. Thanks again.

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