Chart — Palliative & End-of-Life
End-of-Life Comfort Medications Chart
Hospice “comfort kits” contain a short, powerful list of medications chosen because they treat the symptoms of dying and work without IV access. Drug by drug: what it treats, how it’s given when swallowing fails, and the nursing point that matters.
Educational use only. All dosing is determined by provider orders and hospice protocols — this chart covers concepts and typical routes, not doses. Several uses described (atropine drops orally) are deliberate off-label hospice practice under provider direction. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Comfort Kit, Drug by Drug
| Medication | What It Treats | Routes When Swallowing Fails | Key Nursing Points |
|---|---|---|---|
| Morphine (and other opioids) | Pain AND dyspnea/air hunger — the workhorse of comfort care | Concentrated oral solution sublingually/buccally when swallowing fails; subcutaneous; IV where access exists | Schedule around the clock with PRN breakthrough; titrate to symptom relief — comfort care has no ceiling dose, only the dose that works; start the bowel regimen with dose one; double effect protects symptom-targeted titration |
| Lorazepam (benzodiazepines) | Anxiety, agitation, dyspnea-associated panic; adjunct for restlessness | Oral, sublingual (tablet or concentrate), subcutaneous/IV per protocol | Pairs with — doesn't replace — opioids for dyspnea; watch for paradoxical agitation in elders; treat reversible agitation causes (retention, pain) first |
| Haloperidol | Terminal delirium and agitation; also a useful antiemetic at end of life | Oral, sublingual, subcutaneous/IV per protocol | First-line for hyperactive terminal delirium per many protocols; dual benefit (nausea + agitation) makes it a comfort-kit staple |
| Scopolamine patch / glycopyrrolate | Terminal secretions — the death rattle | Transdermal patch (scopolamine); subcutaneous/IV (glycopyrrolate, which crosses into the brain less — less sedation/delirium) | Works on new secretions, not those already pooled — start early, reposition side-lying, and explain to the family; patches take hours to act |
| Atropine 1% ophthalmic drops (given orally) | Terminal secretions — common home-hospice alternative | Drops administered sublingually/buccally | Yes, the eye drops, in the mouth — deliberate off-label hospice practice; easy for families to give at home |
| Acetaminophen / dexamethasone (adjuncts) | Fever and inflammatory discomfort (acetaminophen); pain from edema/pressure, appetite, nausea (dexamethasone) | Rectal/oral (acetaminophen); oral/SubQ/IV (dexamethasone) | Fever in comfort care is treated for comfort, not investigated; steroids serve multiple symptoms at once in advanced disease |
Exam Traps
- ✦Morphine treats terminal dyspnea, not just pain — withholding it because 'respirations are 10' misreads comfort care.
- ✦Symptom-titrated opioid dosing that may hasten death = double effect, ethical and expected; documentation names the symptom.
- ✦Anticholinergics prevent new secretions — start early; deep suctioning the rattle is the wrong answer.
- ✦Concentrated oral morphine works sublingually in unresponsive patients — losing the ability to swallow doesn't mean losing pain control.
- ✦Every scheduled opioid comes with a bowel regimen.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with National Consensus Project (NCP) Clinical Practice Guidelines · Hospice and Palliative Nurses Association (HPNA). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →