Tips for Hospice Nurses: Terminal Agitation

Tip for Hospice Nurses: Terminal Agitation is extreme restlessness that occurs in the last days or weeks of life. Usually the pt is only minimally responsive, and will be thrashing in the bed, fighting any type of intervention, spitting out meds (including liquids), and appears extremely agitated. Some things that may help: 1. Create a familiar environment for your patient. Remember, familiar does not always mean peaceful - many of us lived most of our lives in a loud, noisy, busy world and that is where we are most comfortable. I know for me, I like the TV on, my pets close by and activity going on around me - this is when I am most at peace. It’s important to learn what you can about your patient’s life, their likes/dislikes, and what their environment was like before they got sick - and do your best to recreate that environment. 2. Consider paradoxical drug reaction - in my experience this happens most frequently with Ativan, and simply switching to another benzo can stop the agitation. 3. ABH cream/gel - this is my go to because it’s applied to the skin and after 2-3 applications will usually calm the or enough that they will take their other medication. 4. Valium suppositories - in my experience it takes 10mg (5mg is not effective), and be very careful when inserting, especially if the pt is strong - make sure enough people are there to help you so you don’t get hurt. #tipsforhospicenurses #forhospicenurses #shelleyhenry #hospicenurse #hospicenurses #hospice #agitation #terminalagitation #palliative #palliativecare #environment #familiar #nonpharmaceutical #nonpharmaceuticalinterventions