As someone who is caring for my palliative Dad at home due to Covid-19, I found this really helpful. I've watched a lot of hospice/palliative care videos lately and had never heard about the breathing patterns toward end of life, so thank you for that. As Covid has more people doing palliative care in their own homes please bear in mind you've got an audience of ordinary people like me, trying to educate ourselves on how it's done, what to watch for, what to do about it, how to maintain our sanity in the process.
Of course! You are a hero to me for being a caregiver for your dad! ‘What to expect’ at end of life is something families should be educated on so they can be prepared. Even though your dad is on palliative care I encourage you to reach out to your team and ask questions- that’s what they are there for and I’m sure they’d be more than happy to answer. You are giving your dad such a wonderful gift- to be home and comfortable- do you should be equipped with all the tools and knowledge you need to help the both of you.
I am so glad you suggest massage as an intervention. I am a Hospice massage therapist and gentle massage/touch and a calm presence has so many benefits for many of the symptoms at end of life that you mention. 💕
This is a really helpful video. I'm a new grad LVN and I got a new job and I am learning so much about nursing care on the job. I had no idea morphine was used to help SOB. And I have a resident with cheyne-stokes and its interesting to learn about how to manage it for her. When I saw her still breathing fast after I gave her a breathing treatment, I thought it was weird she was still breathing fast...then it calmed down, she was asleep but I read somewhere the cheyne-stokes occurs often in sleep. Shes on hospice care. Thank you for sharing this video, it's very educational.
Congrats on becoming a nurse! Cheyene stokes is something we definitely see a lot of at end of life; usually when patients are in a semi comatose or actively dying state; sometimes Cheyne stokes indicate an increase in morphine and other times we continue with their regular dosage/frequency depending on the how the patient looks during respirations; if it seems like they’re struggling and it’s uncomfortable then we def will manage that with medications; but as you know, cheyne stokes are not always uncomfortable and are part of the body’s natural process of shutting down. I can tell you’re an amazing nurse just by your willingness to continue your education on subjects even after you graduated!
I appreciate your videos. I have not worked as an R.N. for the last 7 years and now I am applying for jobs at hospice facilities. So I find your videos very helpful.
That’s wonderful! I did try working at one of my companies hospice houses before and they are truly amazing facilities and the nurses are truly amazing as well! Good luck and if you have any questions let me know!
I’m very grateful for your informative videos. I will be working as a hospice nurse in about a week. My main experience has been in Apheresis at a blood bank. I’m very nervous and excited about this major change. Your videos help me to get a head start. Thank you Nurse Allie!
I’m new to hospice and in pt care. Love your videos! Love all the effort you put into your videos despite all the hours you work on top of your job. Thx u much!
This actually really helps me as someone with a loved one in the hospice now. We don’t know how much longer she has but I know even with hospice she’s very uncomfortable. She’s in a lot of pain. I just hope the hospice is taking care of her as best they can.
I am very sorry to hear that. I encourage you to always advocate for your mom if you feel she needs something; as hospice we understand what you’re going through is new territory and we are there to Guide you and do the best we can for our patients. I would also recommend asking them if they have access to a little Blue book called “gone from my sight”; we give this to all of our families; it is a great little book to read that will give you more insight as to what to expect. Never hesitate to ask questions; that’s what we are here for!
Nurse Allie, I just have to say you are amazing. Thank you for making these videos, Very helpful and informative. I am thankful and grateful for you sharing your expertise. 💕💕
omg, tx you so much this one video of yours ...helped me more than the training my agency gave me! i have subscribed and look forward to seeing all of your videos...will binge watch tonight!
That’s wonderful! I’m happy to hear that and thanks so much for subscribing and watching. It really means a lot to me. If you ever have any questions feel free to ask!
My 62 year old brother died 5/9/22. My 90 year old mom took care of him alone in their home the last four months. Hospice didn't really ease her burden.
Sorry to hear about your brother. Hospice is supplementary and is there for guidance as well as hospice services, but the majority of the caretaking is on the primary caregiver.
I like learning from your hospice care I have a 17 yr old in Hosparus Care and he is having pain and things are changing like every 12 hours there a different feeling he has ewings sarcoma spinal cord cancer bone and lyplodes and lung. His cancer came back April of 2021 and treatment did not work. It hard seeing a child in pain dis comfort. He now on more pain meds to control it thanks for helping and getting out information.
Of course! Pain management is one of our top priorities and sometimes it can take a bit to find the right meds and doses to manage them for the rest of their journey; things can also change, but that’s why we are here 24/7! Thank you for all you do for him!
I'd like to know stuff that was obviously NOT discussed. I want to know more medical perspective. So let's say an elderly gentleman is dying in ICU. He's not on a ventilator. He's not on advanced therapies such as ECMO, IABP. He's on a pulse oximeter, ECG monitor, and the ECG monitor incorperates Respiratory Monitoring. Let's say, this patient is an elderly gentleman dying due to Sepsis. His Vasopressors were removed a couple of hours ago. His family is there, by his side. The alarms have been turned down to a low volume. The pulse beep has been turned off. What are the most common end of life rhythms you would see in such a case? Like how often will yo see tachycardia go into V-Tach, then V-Fib to Asystole? What are some other rhythms, you might see in this patient, near death? Do you always see the agonal rhythm, right before Asystole? And does the Agonal come between V-Tach, and V-Fib, or does it come before the V-Tach? I want to know some common rhythms, you might see in these end of life cases.
We don’t monitor heart rhythms in hospice outside of irregular/regular. In hospice we aren’t seeing patients come directly off the vent or on IVs (unless for pain management, but it is rare) every patient is different at end of life, so we don’t see Cheyene- stokes in every patient. If our patient is agonal that means they aren’t comfortable, so in hospice we use morphine or dilaudid for that and possibly Ativan. Like I said though, in hospice we do not see patients coming off of that level of care. Our patients are not typically on their “death bed” or even look sick most of the time. They are in their home comfortably. So I cannot speak to seeing a patient who comes off of a vent and pressors as none of our patients in home hospice present like that.
You were great sharing your experiences. I appreciate you, and the videos you make. I have 17 years an Emergency Department Registered Nurse. I have Med/ Surg experiences as well. Gyn, Post Partum, Post Delivery Recovery. I have 30 years Registered Nurse experience. Will they hire me with mo Hospice experience?
Wow!!! that’s an amazing resume 👏 if I were a hospice agency I would! A lot of hospice is on the job learning, I’m sure in all those years of experience you’ve helped a grieving family or have had hospice involved in a few patients lives in one way or another. I think your experience would be a great addition to a team!
Very informative video on this subject. A rare find. You mentioned that part of Cheyne Stokes involves deep breathing with expanding chest movement.Will all patients go through that? For how long before it becomes shallower and slower - mins, hours, days? Will the patient be conscious or aware of their surroundings/people during Cheyne Stokes and slow breathing phases right to the moment of death? Is Agonal breathing part of Cheyne Stokes or is a form of Cheyne Stokes or is a separate breathing pattern?
Every patient is different. Some have it for a short period of time; it can be shallower breathing for some and more expanded, forced breathing for others; for the patients with the more forceful breathing we look at that as a sing of air hunger and may utilize morphine/dilaudid to help With that air hunger. Most patients are not “conscious” during this time. But they say that hearing is the last sense to go, and therefore we should be mindful of what we say around patients even if they are in a semi-comatose or actively dying phase. Agonal breathing is forceful breathing without the periods of apnea like we see in Cheyen- stokes; they are different types of breathing patterns. Great questions!!!
My dad just died a month ago from CHF. he came home on hospice from the hospital and the o2 sat was in the 80s and the nurse didn't seem to think that was a problem. She also let him drink despite losing his swallowing ability. Everyone assured me he wasn't actively dying and had weeks and months but he died 2 hours after coming home and I think he choked to death while I was out of the room. I went to do something and came back 15 mins later and he was gone. Why would a hospice nurse allow a patient to drink with no swallowing ability? She watched him drink and saw how bad he'd choke but let him continue drinking anyway. I really think that's what killed him
When a patient is on hospice we do not deter them from having their favorite foods/drinks- we educate on the risk for aspiration precautions and risks associated with aspirating. We also cannot stop people from doing what they want and tell them to not drink if they want to. We also don’t treat based on numbers for the most part as well, we treat based on symptoms and the way a patient presents.
@@HospiceNurseAllie thank you for replying to my comment. It has really been bothering me that he might have choked to death versus his CHF flare up because I'm the one that gave it to him. I was only out of his room for about 15 mins and he was just gone. While in the hospital he had a feeding tube because of his swallowing ability. He had battled aspiration pneumonia at least 3 times before he passed and yet he still wanted to drink and he passed about an hour after he was admitted to hospice
Hey! I’m an RN and I just accepted a job as an Admissions Hospice Nurse after being in med/Surg for 3 years. Can you do a video on either stories of patients that really stuck with you or any spiritual things people have said or seen? I may have missed it in previous videos but why did you become a hospice nurse? Thanks for the videos as there aren’t many out there for hospice! 🙂
Ooooohhh I like the way you think! That would be a good one! I’m not sure I even ever addressed it in a video 🤔 but I wanted to become a hospice nurse after seeing my grandmother die in the ICU hooked up to a respirator, my mind got to thinking that there had to be an easier and more peaceful way to go. Fast forward to nursing school, I was drawn to the hospice patients. It was peaceful, dignified, and very fulfilling to me to be able to help patients at such a tender moment in their life. That’s when it clicked for me.
Allie Beth wow, that’s such a hard experience to see your grandma go through. At least one positive thing from it is it pointed you to hospice. Thanks for sharing your story!
Never did I say we didn’t give it. But there’s other ways to provide comfort and pain relief that we need to recognize as well. It isn’t okay to increase medications without recognizing basic needs that may need to be met as well which could also provide comfort. Also, there is no need to be rude. Morphine isnt always the answer to every issue in regards to hospice patients. That’s an archaic way of thinking.
I also did mention roxanol (aka morphine) and dilaudid (aka hydromorphone). I’m assuming that you don’t know the name brands for these medications which is why you jumped to a conclusion. Have a nice day! Be kind!
That’s actually a common myth that opioids such as morphine hasten death. They can cause respiratory depression, which is why morphine is good to use for a patient having labored breathing, but when given in controlled doses and frequencies, should not hasten death. We are not giving it in high enough doses to do so.
Good useless information, but the bladder can hold 250ml easily and comfortably without issue; the only time a foley is warranted is for cancer, bph or sudden onset confusion and agitation due to a UTI.
Interesting! But I wouldn’t say that is true in all cases. We use foleys at end of life due to the fact that a lot of our meds cause urinary retention! The urinary tract will still produce urine regardless of intake so if a patient is having little to no output despite changes in medications for improvement we will try a Foley. We also use them if patients have pressure ulcers and are bed bound so that the area can stay dry and has a better chance of healing! The different used for foleys seem to be endless!
As someone who is caring for my palliative Dad at home due to Covid-19, I found this really helpful. I've watched a lot of hospice/palliative care videos lately and had never heard about the breathing patterns toward end of life, so thank you for that. As Covid has more people doing palliative care in their own homes please bear in mind you've got an audience of ordinary people like me, trying to educate ourselves on how it's done, what to watch for, what to do about it, how to maintain our sanity in the process.
Of course! You are a hero to me for being a caregiver for your dad! ‘What to expect’ at end of life is something families should be educated on so they can be prepared. Even though your dad is on palliative care I encourage you to reach out to your team and ask questions- that’s what they are there for and I’m sure they’d be more than happy to answer. You are giving your dad such a wonderful gift- to be home and comfortable- do you should be equipped with all the tools and knowledge you need to help the both of you.
I am so glad you suggest massage as an intervention. I am a Hospice massage therapist and gentle massage/touch and a calm presence has so many benefits for many of the symptoms at end of life that you mention. 💕
I agree! It has so many benefits! Thank you for all you do for hospice patients; you really have a gift ♥️
This is a really helpful video. I'm a new grad LVN and I got a new job and I am learning so much about nursing care on the job. I had no idea morphine was used to help SOB. And I have a resident with cheyne-stokes and its interesting to learn about how to manage it for her. When I saw her still breathing fast after I gave her a breathing treatment, I thought it was weird she was still breathing fast...then it calmed down, she was asleep but I read somewhere the cheyne-stokes occurs often in sleep. Shes on hospice care. Thank you for sharing this video, it's very educational.
Congrats on becoming a nurse! Cheyene stokes is something we definitely see a lot of at end of life; usually when patients are in a semi comatose or actively dying state; sometimes Cheyne stokes indicate an increase in morphine and other times we continue with their regular dosage/frequency depending on the how the patient looks during respirations; if it seems like they’re struggling and it’s uncomfortable then we def will manage that with medications; but as you know, cheyne stokes are not always uncomfortable and are part of the body’s natural process of shutting down. I can tell you’re an amazing nurse just by your willingness to continue your education on subjects even after you graduated!
I work in an area with a high religiosity rate and I've seen that reading their religious texts to them can help with anxiety
That’s such a great idea! And very sweet of you to take the time to do so! You’re patients are lucky to have you!
I appreciate your videos. I have not worked as an R.N. for the last 7 years and now I am applying for jobs at hospice facilities. So I find your videos very helpful.
That’s wonderful! I did try working at one of my companies hospice houses before and they are truly amazing facilities and the nurses are truly amazing as well! Good luck and if you have any questions let me know!
I’m very grateful for your informative videos. I will be working as a hospice nurse in about a week. My main experience has been in Apheresis at a blood bank.
I’m very nervous and excited about this major change. Your videos help me to get a head start. Thank you Nurse Allie!
I am so happy for you! Welcome to the team! You’re going to love it 🥰 feel free to message me on IG @nurse_allie if you need anything!
This was honestly the 12th video I searched for and it was perfectly what I needed. I loved your "teachy talking" style.
Thank you so much for saying that! Sometimes I do feel like my videos can be more like a lecture but I do my best 😆 I appreciate your comment so much!
I’m new to hospice and in pt care. Love your videos! Love all the effort you put into your videos despite all the hours you work on top of your job. Thx u much!
Thank you so much!! I really do my best! And I try to improve along the way😊 your comment means a lot to me
This actually really helps me as someone with a loved one in the hospice now. We don’t know how much longer she has but I know even with hospice she’s very uncomfortable. She’s in a lot of pain. I just hope the hospice is taking care of her as best they can.
I am very sorry to hear that. I encourage you to always advocate for your mom if you feel she needs something; as hospice we understand what you’re going through is new territory and we are there to Guide you and do the best we can for our patients. I would also recommend asking them if they have access to a little
Blue book called “gone from my sight”; we give this to all of our families; it is a great little book to read that will give you more insight as to what to expect. Never hesitate to ask questions; that’s what we are here for!
Nurse Allie, I just have to say you are amazing. Thank you for making these videos, Very helpful and informative. I am thankful and grateful for you sharing your expertise. 💕💕
Thank you so much for watching!!
I just started working hospice this past month and your videos are so helpful!
Im going into hospice tmrw very scared when palliative care told me im so young, but know there are nurses like you i feel better
omg, tx you so much this one video of yours ...helped me more than the training my agency gave me! i have subscribed and look forward to seeing all of your videos...will binge watch tonight!
That’s wonderful! I’m happy to hear that and thanks so much for subscribing and watching. It really means a lot to me. If you ever have any questions feel free to ask!
As a new Hospice nurse I have found your videos to be very informative and helpful. Thank you for sharing your knowledge and experience.
Thank you so much for your comment! It really does mean a lot
Im a new hospice nurse and I love these thank you so much!!
Thank you for watching! So excited for you!! Hospice is a hidden gem in the nursing world
Hey girlie I love your channel. I have been a hospice lvn for 20 yrs and hospice rn for 8 months.
That’s amazing! Thank you so much for your support ❤️
My 62 year old brother died 5/9/22. My 90 year old mom took care of him alone in their home the last four months. Hospice didn't really ease her burden.
Sorry to hear about your brother. Hospice is supplementary and is there for guidance as well as hospice services, but the majority of the caretaking is on the primary caregiver.
Thanks for sharing this video. It was very informative and helpful.
Thank you for watching!!!
Good teaching
Good information.I have worked in hospice for 23 years.💞
That’s amazing!
@@HospiceNurseAllie 💞
I like learning from your hospice care I have a 17 yr old in Hosparus Care and he is having pain and things are changing like every 12 hours there a different feeling he has ewings sarcoma spinal cord cancer bone and lyplodes and lung. His cancer came back April of 2021 and treatment did not work. It hard seeing a child in pain dis comfort. He now on more pain meds to control it thanks for helping and getting out information.
Of course! Pain management is one of our top priorities and sometimes it can take a bit to find the right meds and doses to manage them for the rest of their journey; things can also change, but that’s why we are here 24/7! Thank you for all you do for him!
Thank you nurse Allie ❤❤❤❤❤
Thank you for a very straightforward explanation greatly appreciated
I’m glad it was helpful! Thank you for your comment!
My 62 year old brother died 5/9/22. My 90 year old mom took care of him the last four months alone. Hospice came daily but the burden was on my mom
You have a very strong momma! Bless her heart!
This is great for a newbie to hospice, like me!
Thank you for watching! I’m glad you learned something from lil old me 😆
@@HospiceNurseAllie if you have any more advice on anything hospice related that would be great
My mother has been placed in home hospice. Thanks this was helpful
Wishing you all the best in your journey! Remember to utilize your hospice team whenever you need to😊
Awesome video! Thank you for all that you do! ❤
Thank you for your comment and for watching ❤️ means a lot to me! Being a nurse is definitely a calling!
Thank you! - nursing student
Thank you I am starting hospice nursing as a new grad
That’s amazing! Congratulations!
Very informative. Thanks.
Appreciate this. Thanks. ❤
I'd like to know stuff that was obviously NOT discussed. I want to know more medical perspective. So let's say an elderly gentleman is dying in ICU. He's not on a ventilator. He's not on advanced therapies such as ECMO, IABP. He's on a pulse oximeter, ECG monitor, and the ECG monitor incorperates Respiratory Monitoring. Let's say, this patient is an elderly gentleman dying due to Sepsis. His Vasopressors were removed a couple of hours ago. His family is there, by his side. The alarms have been turned down to a low volume. The pulse beep has been turned off. What are the most common end of life rhythms you would see in such a case? Like how often will yo see tachycardia go into V-Tach, then V-Fib to Asystole? What are some other rhythms, you might see in this patient, near death? Do you always see the agonal rhythm, right before Asystole? And does the Agonal come between V-Tach, and V-Fib, or does it come before the V-Tach? I want to know some common rhythms, you might see in these end of life cases.
We don’t monitor heart rhythms in hospice outside of irregular/regular. In hospice we aren’t seeing patients come directly off the vent or on IVs (unless for pain management, but it is rare) every patient is different at end of life, so we don’t see Cheyene- stokes in every patient. If our patient is agonal that means they aren’t comfortable, so in hospice we use morphine or dilaudid for that and possibly Ativan. Like I said though, in hospice we do not see patients coming off of that level of care. Our patients are not typically on their “death bed” or even look sick most of the time. They are in their home comfortably. So I cannot speak to seeing a patient who comes off of a vent and pressors as none of our patients in home hospice present like that.
Definitely would direct these questions towards an ICU nurse. They could def give you a more detailed anwer.
You were great sharing your experiences. I appreciate you, and the videos you make. I have 17 years an Emergency Department Registered Nurse. I have Med/ Surg experiences as well. Gyn, Post Partum, Post Delivery Recovery. I have 30 years Registered Nurse experience. Will they hire me with mo Hospice experience?
Wow!!! that’s an amazing resume 👏 if I were a hospice agency I would! A lot of hospice is on the job learning, I’m sure in all those years of experience you’ve helped a grieving family or have had hospice involved in a few patients lives in one way or another. I think your experience would be a great addition to a team!
Thank you for the video, very helpful and informative
Very informative video on this subject. A rare find.
You mentioned that part of Cheyne Stokes involves deep breathing with expanding chest movement.Will all patients go through that? For how long before it becomes shallower and slower - mins, hours, days?
Will the patient be conscious or aware of their surroundings/people during Cheyne Stokes and slow breathing phases right to the moment of death?
Is Agonal breathing part of Cheyne Stokes or is a form of Cheyne Stokes or is a
separate breathing pattern?
Every patient is different. Some have it for a short period of time; it can be shallower breathing for some and more expanded, forced breathing for others; for the patients with the more forceful breathing we look at that as a sing of air hunger and may utilize morphine/dilaudid to help
With that air hunger.
Most patients are not “conscious” during this time. But they say that hearing is the last sense to go, and therefore we should be mindful of what we say around patients even if they are in a semi-comatose or actively dying phase.
Agonal breathing is forceful breathing without the periods of apnea like we see in Cheyen- stokes; they are different types of breathing patterns.
Great questions!!!
My dad just died a month ago from CHF. he came home on hospice from the hospital and the o2 sat was in the 80s and the nurse didn't seem to think that was a problem. She also let him drink despite losing his swallowing ability. Everyone assured me he wasn't actively dying and had weeks and months but he died 2 hours after coming home and I think he choked to death while I was out of the room. I went to do something and came back 15 mins later and he was gone. Why would a hospice nurse allow a patient to drink with no swallowing ability? She watched him drink and saw how bad he'd choke but let him continue drinking anyway. I really think that's what killed him
When a patient is on hospice we do not deter them from having their favorite foods/drinks- we educate on the risk for aspiration precautions and risks associated with aspirating. We also cannot stop people from doing what they want and tell them to not drink if they want to. We also don’t treat based on numbers for the most part as well, we treat based on symptoms and the way a patient presents.
@@HospiceNurseAllie thank you for replying to my comment. It has really been bothering me that he might have choked to death versus his CHF flare up because I'm the one that gave it to him. I was only out of his room for about 15 mins and he was just gone. While in the hospital he had a feeding tube because of his swallowing ability. He had battled aspiration pneumonia at least 3 times before he passed and yet he still wanted to drink and he passed about an hour after he was admitted to hospice
good job
Thank you 😁
👍🙏
Hey! I’m an RN and I just accepted a job as an Admissions Hospice Nurse after being in med/Surg for 3 years. Can you do a video on either stories of patients that really stuck with you or any spiritual things people have said or seen? I may have missed it in previous videos but why did you become a hospice nurse? Thanks for the videos as there aren’t many out there for hospice! 🙂
Ooooohhh I like the way you think! That would be a good one! I’m not sure I even ever addressed it in a video 🤔 but I wanted to become a hospice nurse after seeing my grandmother die in the ICU hooked up to a respirator, my mind got to thinking that there had to be an easier and more peaceful way to go. Fast forward to nursing school, I was drawn to the hospice patients. It was peaceful, dignified, and very fulfilling to me to be able to help patients at such a tender moment in their life. That’s when it clicked for me.
And also congrats on the job girl!! 🥳
Allie Beth thank you!
Allie Beth wow, that’s such a hard experience to see your grandma go through. At least one positive thing from it is it pointed you to hospice. Thanks for sharing your story!
Ummm. How about morphine. To not give it is reprehensible. What’s the matter with u. Should be no pain or discomfort in anyway
Never did I say we didn’t give it. But there’s other ways to provide comfort and pain relief that we need to recognize as well. It isn’t okay to increase medications without recognizing basic needs that may need to be met as well which could also provide comfort. Also, there is no need to be rude. Morphine isnt always the answer to every issue in regards to hospice patients. That’s an archaic way of thinking.
I also did mention roxanol (aka morphine) and dilaudid (aka hydromorphone). I’m assuming that you don’t know the name brands for these medications which is why you jumped to a conclusion. Have a nice day! Be kind!
Doesn’t opioids make the passing process faster?
That’s actually a common myth that opioids such as morphine hasten death. They can cause respiratory depression, which is why morphine is good to use for a patient having labored breathing, but when given in controlled doses and frequencies, should not hasten death. We are not giving it in high enough doses to do so.
No, it makes it easier and more comfortable when someone is suffering
You are very pretty
Good useless information, but the bladder can hold 250ml easily and comfortably without issue; the only time a foley is warranted is for cancer, bph or sudden onset confusion and agitation due to a UTI.
Interesting! But I wouldn’t say that is true in all cases. We use foleys at end of life due to the fact that a lot of our meds cause urinary retention! The urinary tract will still produce urine regardless of intake so if a patient is having little to no output despite changes in medications for improvement we will try a Foley. We also use them if patients have pressure ulcers and are bed bound so that the area can stay dry and has a better chance of healing! The different used for foleys seem to be endless!
@@HospiceNurseAllie I meant useful* information
Beeping sounds??