A patient with schizophrenia has just been assigned to hospice ...

[meagbuch]

A patient with schizophrenia has just been assigned to hospice care. When contacting the health care provider for medication on admission of the patient to hospice, what orders should the nurse request in addition to medication for pain control?
 
  1. Antipsychotic medication should be continued at the same dosage.
  2. Antipsychotic medication should be immediately discontinued.
  3. Antipsychotic medication dosage should be increased.
  4. Antipsychotic medication should be discontinued after one to two weeks in hospice.

Question 2

A patient with end stage pancreatic cancer and dementia is assigned to a nurse for hospice care. How can the nurse effectively provide an ongoing assessment of this patient's pain?
 
  1. Periodically ask the patient to rank the pain on a scale of one to ten.
  2. Observe the patient regularly and write anecdotal reports.
  3. Observe the patient regularly and score on a scale of observable reactions.
  4. Periodically ask the patient to rank the pain on a visual scale from high to low.

[mohan]

Answer to Question 1

Answer: 1
Explanation: If a patient had been prescribed antidepressant or antipsychotic medication, discontinuing these medications at the initiation of hospice care might be counterproductive and create unneeded emotional distress. The medication should be ordered and administered at the same dosage and frequency until patient assessment determines a need for change. As in all aspects of nursing care, patient preferences must be assessed and taken into consideration but the decision requires a considered collaboration between the patient and all members of the hospice team.

Answer to Question 2

Answer: 3
Explanation: The Pain Assessment in Advanced Dementia (PAINAD) scale uses categories of behavior observed by the nurse to rate the patient's pain. This measurement can provide comparable scores from one observation to the next. The numerical scale and visual scales that require either verbal communication or understanding may not elicit an accurate response from a patient with dementia. Anecdotal reports do not provide an efficient method of comparison.