Date	Time	Check Desired Orders
			Code Status: r See Intensity of Intervention Orders
			Vital Signs: r D/C r q Shift r q Day r D/C Weights r D/C Telemetry
			Lab: r D/C Routine Lab r Other_______________________________________ Activity Level: r Reposition and activity as tolerated
			Nutrition: r D/C Artificial Nutrition r Diet as tolerated r Other _______________
			IV: r D/C IV r D/C Central Line r Saline lock present IV
			r Continue present IV at 30/cc hr.
			r If IV infiltrates may convert meds to s.q. infusion per Pharmacy
			Respiratory: r O2 PRN comfort r D/C O2 r D/C Sats
			For Opiate Naive: r Morphine 2.5mg to 5mg IV or s.q. q _____hr PRN respiratory distress
			r Morphine 10mg p.o. 1 q ____ hr PRN respiratory distress
			For Opiate Tolerant: r use 1 to 2 times the hourly dose of their pain medication
			For Secretions r Reposition or gentle suction PRN
			r Robinul 0.1mg to 0.2mg q 4 hrs s.q. q ____ hr PRN respiratory secretions
			r Atropine 0.4mg to 2mg p.o. q _____ hr PRN respiratory secretions
			r Scopolamine Transderm Patch. Change q 72 hrs PRN respiratory secretions
			Anxiety/Restlessness/Delirium:
			r Lorazepam 0.5mg to 2mg p.o./s.l./s.q. or IV q ______ hr PRN anxiety/restlessness
			r Haloperidol 1-2mg p.o./s.q. or IV q 4 hrs PRN anxiety/restlessness
			r Droperidol 0.625 po/ IV 4 hrs PRN anxiety/ restlessness
			Nausea: r Compazine 10mg p.o. q 6 hrs or 25mg supp q 12 hrs PRN nausea
			r Doperidol .0625mg po/ IV q 4 hrs PRN nausea
			Anti-emetic Mix r Haldol 1mg r Ativan 2mg r Decadron 4mg q 4-6 hrs po PRN nausea
			Pain:
			Mild to Moderate: r See PCA Sheet Deleted extra here
			r Oxyfast IR 5-10mg p.o. q 1-2 hrs PRN breakthrough pain
			r Roxanol 5-10mg p.o. q 1-2 hrs PRN breakthrough pain
			r Vioxx 25mg to 50mg p.o. q day PRN pain
			r Others:
			Moderate to Severe: r See PCA sheet Deleted extra here
			r Oxyfast IR 20mg to ____ p.o. or s.l. q ____ hrs PRN pain
			r Roxanol 20 mg to ___ p.o. or s.l. q ____ hrs PRN pain
			r Morphine 2mg ___ mg IV / SQ q ____ hrs PRN pain
			r Dilaudid 0.5 mg to ___mg IV / SQ q ____ hrs PRN pain
			r Call for more orders as needed
			Adjuvant Analgesics: r Vioxx 25mg to 50mg p.o. q day PRN pain
			r Ibuprofin 200-800 mg PO q 8 hrs
			r Toradol 15-30 mg IV q 8 hrs
			r Dexamethasone 2-24 mg PO or IV q day
			r Amitriptyline 10-50 mg po q hs (neuropathic pain … titrate slowly)
			r Neurontin 100-12—mg PO q 8 hrs (neuropathic pain … titrate slowly)
			Bowel Regimen: r DSS 100 mg PO BID
			r Senna 1-6 PO BID (titrate to effect)
			r Ducolax suppository 5 mg PR PRN q 4 hrs
			r Lactulose 15-30 cc PO q 8 hrs PRN
			r Convert appropriate pain meds from p.o. to IV or s.q. per pharmacy r Convert appropriate pain meds from PRN to scheduled long-acting equianalgesics
			Discontinue medication:
			Nursing	Institute Nursing Procedure: End Of Life Comfort Care
________________________ Date					____________________ Time	_______________________________________________ MD Signature