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レジデントノート

米国にて内科修行中。何ができるか模索している過程を記録していく

End of Life Comfort Care

Nurse order

Provide private room

Visitor okay pre-post normal hours

 

食事

Regular diet(持ち込み可)

 

コンサルテーション

Pain management consult

Social service consult

Spiritual care consult

 

疼痛コントロール

- Morphine (20mg/1ml solution) 10/20mg sublingual Q1H PRN for pain

- Morphine 1/2/4mg IV Q1H PRN for pain

- Morphine IV (100mg/NS100cc) 持続

start at 1mg/hr, titrate by 1mg/hr every 5 minutes, maximum dose: none

 

- Hydromorphone 0.2/0.4mg IV Q4H PRN for severe pain

- Hydromorphone IV (50mg/NS50cc) 持続

start at 0.2mg/hr, titrate to patient comfort

 

- Fentanyl Patch 12/25/50/75/100mcg/hr Q3D SCH

  

- Acetaminophen 650mg PO Q4H PRN

- Acetaminophen 650mg PO Q6H SCH

 

掻痒時

- Diphenhydramine 25mg PO Q4H PRN for pruritis

- Diphenhydramine 25mg IV Q4H PRN for pruritis

 

便秘時

- Senna-Docusate 2 tab PO HS PRN for constipation

- Bisacodyl Suppository 10mg PR DAILY PRN for constipation

 

口腔内分泌過多時

- Scopolamine 1.5mg/72hr Patch 1 patch TD Q72H PRN for excess secretions

- Hyoscyamine 0.125mg PO Q4H PRN for excess secretions

 

不安時

- Lorazepam 1mg PO Q4H PRN for agitation

- Lorazepam 1mg IV Q2H PRN for agitation

 

不眠時

- Haloperidol 1mg PO HS PRN for sleep

 

嘔気時

- Prochlorperazne 10mg PO Q6H PRN for nausea/vomiting

- Ondansetron 4mg IV Q6H PRN for nausea/vomiting

- Prochlorperazine 25mg PR Q12H PRN for nausea/vomiting

 

(米国一施設基準)