Manejo farmacológico de la sedación paliativa en la agonía / Pharmacological treatment in end-of-life sedation

Objetivo. Para el control de los síntomas físicos en situación de últimos días el manejo farmacológico supone la intervención principal. El objetivo de este artículo es revisar las cuestiones relevantes en el manejo enfermero de las situación clínicas y los fármacos comúnmente usados en sedación paliativa en la agonía. Metodología. Se seleccionan las intervenciones sobre manejo enfermero de fármacos en sedación paliativa recomendadas por la literatura científica mediante búsqueda realizada en Scopus, CINAHL, Medline-PubMed y Google Académico con las palabras clave «sedación paliativa», «farmacología», «cuidados de enfermería» y «cuidados paliativos». Resultados. El objetivo de la sedación paliativa (SP) es disminuir el nivel de conciencia como única forma de aliviar un sufrimiento intenso en pacientes en situación terminal, tal como delirium, dolor o disnea refractarias, hemorragia masiva, estado convulsivo, estertores premortem o sufrimiento psicológico refractario. La vía de elección en SP es la vía subcutánea (sc). Son fármacos de 1.ª línea en sedación el midazolam y la levomepromazina. Los opioides deben mantenerse en dosis equianalgésicas, siendo el cloruro mórfico el de uso más extendido. El papel fundamental de enfermería en SP es la monitorización del nivel de sedación según la escala de Ramsay (o similar) y el reconocimiento de los signos indicativos de malestar para la administración de rescate de medicación sedante o analgésica o despistaje de proceso intercurrente tratable (globo vesical, fecaloma, obstrucción de vía, efecto final de dosis, etc.) (AU)

Objetive. To control the physical symptoms in end-of-life pharmacological management involves major intervention. The aim of this article is to review the relevant issues in the management of clinical nursing situation and drugs commonly used in palliative sedation in agony. Methodology. Nursing management in Palliative Sedation recommended by scientific literature search in Scopus, CINAHL, Medline-PubMed and Google Scholar, with key words: «palliative sedation», «pharmacology», «nursing care» and «palliative care» are selected. Results. The goal of palliative sedation (PS) is to reduce the level of consciousness as the only way to relieve intense suffering in terminally ill patients, such as refractory delirium or dyspnea, massive bleeding, convulsive status, crackles premortem or refractory psychological suffering. The route of choice in PS is subcutaneous injection (sc). First line drugs in sedation are midazolam and levomepromazina. Opioids should be kept at equi-analgesic doses, morphine chloride being the most widely used. The fundamental role of nursing in SP is monitoring the level of sedation based on the Ramsay scale (or similar) and recognition of the indicative signs of discomfort for administration rescue sedative or analgesic medication and/or screening treatable intercurrent process (distended bladder, constipation, obstruction way, final dose effect, etc.) (AU)

[Pharmacological Treatment in End-of-Life Sedation]. / Manejo farmacológico de la sedación paliativa en la agonía.

Objective: To control the physical symptoms in end-of-life pharmacological management involves major intervention. The aim of this article is to review the relevant issues in the management of clinical nursing situation and drugs commonly used in palliative sedation in agony. Methodology: Nursing management in Palliative Sedation recommended by scientific literature search in Scopus, CINAHL, Medline-PubMed and Google Scholar, with key words "palliative sedation", "pharmacology", "nursing care" and "palliative care" are selected. Results: The goal of palliative sedation (PS) is to reduce the level of consciousness as the only way to relieve intense suffering in terminally ill patients, such as refractory delirium or dyspnea, massive bleeding, convulsive status, crackles premortem or refractory psychological suffering. The route of choice in PS is subcutaneous injection (sc). First line drugs in sedation are midazolam and levomepromazina. Opioids should be kept at equi-analgesic doses, morphine chloride being the most widely used. The fundamental role of nursing in SP is monitoring the level of sedation based on the Ramsay scale (or similar) and recognition of the indicative signs of discomfort for administration rescue sedative or analgesic medication and/or screening treatable intercurrent process (distended bladder, constipation, obstruction way, final dose effect, etc.).

[PHARMACOLOGICAL TREATMENT IN PALLIATIVE CARE. DRUG ADMINISTRATION ROUTE, CONTINUOUS SUBCUTANEOUS INFUSION, ADVERSE SIDE EFFECTS, SYMPTOM MANAGEMENT]. / Farmacoogía en Cuidados Paliativos.

OBJECTVE: To achieve well-being in patients in Palliative Care is required to know which are the most common symptoms, which are the drugs used for relief, which are the routes of administration of drugs that are suitable, how effective the drugs are and what incompatibilities, interactions and adverse effects occur. The aim of this article is to review the relevant issues in the management of the drugs commonly used by nursing in Palliative Care and presenting recommendations to clinical practice. METHODOLOGY: Management interventions drugs for nurses in Palliative Care recommended by the scientific literature after a search of Scopus, CINAHL, Medline, PubMed, UpToDate and Google Scholar are selected. RESULTS: The oral route is the choice for patients in palliative situation and subcutaneous route when the first is not available. The symptoms, complex, intense and moody, should be systematically reevaluated by the nurse, to predict when a possible decompensation of it needing extra dose of medication. DISCUSSION: Nurses must be able to recognize the imbalance of well-being and act quickly and effectively, to get relief to some unpleasant situations for the patient as the pain symptoms, dyspnea or delirium. For the proper administration of rescue medication, the nurse should know the methods of symptomatic evaluation, pharmacokinetics and pharmacodynamics of drugs, the time intervals to elapse between different rescues and nccocc rocnnnco t thocm

Farmacología en cuidados paliativos. Vías de administración, mezclas, efectos secundarios frecuentes, normas básicas para el control de síntomas / Pharmacological treatment in palliative care. Drug administration route, continuous subcutaneous infusion, adverse side effects symptom management

Objetivo. Para lograr el bienestar del paciente en Cuidados Paliativos (CP) es obligado conocer cuáles son los síntomas más frecuentes, qué fármacos se utilizan para su alivio, cuáles son las vías de administración, qué efectividad demuestran y qué incompatibilidades, interacciones y efectos adversos. El objetivo de este artículo es revisar las cuestiones relevantes en el manejo enfermero de los fármacos comúnmente usados en CP y presentar recomendaciones orientadas a la práctica clínica. Metodología. Se seleccionan las intervenciones sobre manejo enfermero de fármacos en CP recomendadas por la literatura científica tras una búsqueda realizada en Scopus, CINAHL, Medline-Pubmed, UpToDate y Google Académico. Resultados. La vía oral es la de elección en el paciente en situación paliativa, y la subcutánea cuando no está disponible la primera. La sintomatología, compleja, intensa y cambiante, debe reevaluarse de forma sistemática por el profesional de enfermería, y contrarrestar posibles descompensaciones impredecibles de la misma con una dosis extra de medicación. Discusión. El personal de enfermería ha de saber reconocer la descompensación y actuar rápida y eficazmente en el alivio de una sintomatología tan desagradable para el paciente como el dolor, la disnea o el delírium. Para la administración correcta de la medicación de rescate, el personal de enfermería debe conocer los métodos de evaluación sintomática, las características farmacocinéticas y farmacodinámicas de los fármacos, los intervalos de tiempo que deben transcurrir entre diferentes rescates y evaluar la respuesta a los mismos (AU)

Objective. To achieve well-being in patients in Palliative Care is required to know which are the most common symptoms, which are the drugs used for relief, which are the routes of administration of drugs that are suitable, how effective the drugs are and what incompatibilities, interactions and adverse effects occur. The aim of this article is to review the relevant issues in the management of the drugs commonly used by nursing in Palliative Care and presenting recommendations to clinical practice. Methodology. Management interventions drugs for nurses Palliative Care recommended by the scientific literature after a search of Scopus, CINAHL, Medline, PubMed, UpToDate and Google Scholar are selected. Results. The oral route is the choice for patients in palliative situation and subcutaneous route when the first is not available. The symptoms, complex, intense and moody, should be systematically reevaluated by the nurse, to predict when a posible decompensation of it needing extra dose of medication. Discussion. Nurses must be able to recognize the imbalance of well-being and act quickly and effectively, to get relief to some unpleasant situations for the patient as the pain symptoms, dyspnea or delirium. For the proper administration of rescue medication, the nurse should know the methods of symptomatic evaluation, pharmacokinetics and pharmacodynamics of drugs, the time intervals to elapse between different rescues and assess response to them (AU)