Nearly 60 transplants were performed through March 31 for patients with covid-related organ disease, according to figures released Monday by the United Network for Organ Sharing, which oversees transplants in the U.S. That includes at least 54 lung and four heart transplants recorded since new codes for covid-specific diagnoses were adopted in late October. One patient received a combination heart-lung transplant. Another 26 patients eligible for covid-related lung transplants and one eligible for a heart transplant remain on waiting lists, UNOS data show.
斯坦福大学医学中心(Stanford University Medical Center)肺和心肺移植项目前主任、现为顾问的大卫·威尔(David Weill)博士说，“你可以看到这种趋势在全国蔓延，而且蔓延得很快。”“这就像野火一样，中心都在说，‘我们也做了第一个。’”
我们希望下面提出的两种案例研究将说明几个姑息治疗干预措施，并突出了RNS和LNA在治疗痛苦中的作用。 We hope this article has given you a better sense of what palliative care has to offer, and also how RNs and LNAs, because of their scope of practice, are in a unique and privileged place to provide this care.
艾莉森正在患上癌症地板，腹痛与阶段卵巢癌相关。莎拉是她的晚上班次的护士。 Alison’s pain requires regular use of her PRN dose just to keep it under control. She also shares that she is not sure that she wants to continue chemotherapy. Sarah calls the attending and recommends a palliative care consult. “Alison is using frequent PRN doses and I feel her symptoms could be better controlled. She is struggling with what her care should look like going forward.” The attending physician is convinced and orders a palliative care consultation.
Over the course of Alison’s hospitalization, she is started on scheduled doses of long-acting morphine, and her pain decreases. She rarely requires PRN doses. However, then at a family meeting her oncologist shares that there are no more cancer treatments available. Alison asks Sarah’s opinion about whether or not she should go home on hospice. Sarah assesses Alison’s understanding, asking her what she knows about hospice. Alison answers that she is not sure, but that her doctors said since there are no more cancer treatments she should “consider hospice.” Sarah describes hospice as an extra layer of support to help people make the most of the time they have left, and when they are closer to dying, to ensure they have a peaceful death. Alison starts to tear up and asks, “Does this mean I am dying now?”
作为回应，莎拉轻轻地要求艾莉森说更多关于她的感受。艾莉森继续分享她希望她有更多的时间与她的儿子一起度过，并且能够看到他的更多网球比赛。莎拉回应，“我希望你能够这样做。” Alison goes on to tell you more about her son and her attempts to ask him about her illness. Sarah shares that hospice can also provide support for having these conversations and will also be there to provide bereavement support for Alison’s family after her death. After Sarah spends time addressing Alison’s concerns while also responding to her emotions, Alison seems more at peace.
这美国临终关怀和姑息医学(AAHPM) describes palliative care as “patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering,” which feels very closely aligned both with nursing’s traditional focus on holistic, person-centered care, and with the American Nurses Association’s philosophy of nursing (ANA网站，2015年）强调患有痛苦和患者和家庭的护理的缓解。我们一直受到护理和姑息治疗之间的强烈共鸣，它的一部分激励我们在专门针对RNS和LNA的姑息治疗中写下这篇文章。
鉴于护理与姑息治疗哲学的一致性，RNS和LNA是姑息治疗的核心并不奇怪。有些人可能会在生命结束时帮助照顾患者和家庭;大多数人都有可能关心严重或危险的疾病的患者，并且你们所有人都看到了你的患者和家人如何受到影响。As such, you are uniquely positioned to help relieve that suffering, whether it’s through the swift identification of symptoms, the timely delivery of appropriate medication, the willingness to offer therapeutic presence to someone in psychological or emotional distress, or the courage to advocate for patients or families in distress.
在我们进一步进一步之前，定义您可能遇到的一些术语可能会有所帮助。你们中的许多人可能已经听过“姑息的护理”，“临终关怀护理”或“舒适护理”在某种程度上使用了一些互动，但在真理中存在重要差异。例如，虽然姑息性护理和临终关怀专注于识别患者目标和价值，治疗繁重的症状，以及优化生活质量，姑息治疗可以在任何疾病的任何阶段（从诊断时），并可提供与疾病导向治疗一起。 Hospice, on the other hand, while essentially identical to palliative care in terms of treatment, focuses on patients with an expected prognosis of six months or less who have elected to forgo further curative treatment.
诸如“舒适性”或“舒适度”之类的术语也常用，特别是以提供者之间的“商店谈话”形式（例如，在转变期间），但使用“仅限舒适措施”或“CMO” is discouraged as it implies a limited form of care, as in “you’re只要获得这种有限的治疗形式，而不是整个Enchilada“。不幸的是，许多提供者，患者和家庭都有这种想法，姑息治疗意味着失败（患者失败，“战斗”或提供者失败“治愈”），因此是一个安慰奖，a二手形式的医疗保健。您有时可能会看到这种态度，在提供者中依稀指示姑息治疗，只需“用吗啡加载它们”。
症状的医学管理是姑息治疗的重要组成部分。疼痛往往是患者最令人痛苦的症状，但呼吸困难，恶心和呕吐，便秘，抑郁和焦虑也可以大大减少某人的生活质量。我们使用熟悉的药物，例如阿片类药物和NSAIDs，泻药，抗惊厥药，SSRIS和苯二氮卓类药物，但我们有时以不熟悉的方式使用它们（使用Haloperidol以治疗恶心）。通过治疗症状，我们经常设法治疗痛苦（例如，患者可能遭受恐惧，因为他们将永远处于痛苦，而通过缓解疼痛，我们也可以缓解这种恐惧）。但有时只是治疗症状也不足以缓解痛苦，这就是为什么姑息治疗大部分姑息治疗与患者及其家人的谈话形式，我们试图与患者和/或家人一起探索are for them, and the ways in which they’re suffering as a result of their situation.
我们称之为这些对话“护理谈话的目标”，因为我们希望他们希望在治疗结果（例如，“我想成为无痛，”或“我想全部成本的情况来确定特定人物“）。一旦我们与患者合作识别这些目标，我们就可以使用它们来创建一个“目标交易”的护理计划，或者与他们的愿望保持一致。有些患者的目标是舒适，在家死亡，而其他人则希望“一切都完成”，并接受这意味着他们可能会在ICU中死亡。实际上，大多数人都想要在介于两者之间，导航在生活质量和生命的长度之间的一些权衡。这se goals of care conversations may seem unique in some ways (the specifics of each patient’s lived experience) and in the dynamics, the back-and-forth or the “dance” of the conversation itself, but the deeper truth is that all of these conversations begin and end in the place where a human being confronts and attempts to reconcile themselves to their mortality, to the fact that they (that each of us) is going to die.