The Novel Coronavirus SARS-CoV-2 (COVID-19) pandemic is changing how we deliver expert palliative care. We can expect many to die prematurely secondary to COVID-19 across the United States. We present a case of how several hospital systems-based interventions, intended to slow viral spread and to protect health care workers, have inadvertently created barriers to routine palliative interventions in this patient population. Isolation of patients, limitation of visitors and interdisciplinary support, and changes in nursing and provider assessment have all had their impact on how we deliver palliative care. These barriers have altered many aspects of our established workflow and algorithms for care, including changes in communication, goals of care discussions, how providers and nurses are monitoring for symptoms, and end-of-life monitoring. These challenges required real-time solutions such as technology utilization, proposing a change in medical delivery systems, and reducing redundancy to preserve personal protective equipment. To continue to deliver quality care for this patient population, palliative medicine must adapt quickly.We present a case that illustrates how safety precautions implemented for COVID-19 have created unique barriers to assessing and treating symptoms in this patient population at the end of life and changes made within our system to overcome these barriers.

Dry mouth, hiccups, fevers, pruritus, and sleep disorders are symptoms often found in palliative care patients. They can be challenging to treat and require the palliative advanced practice registered nurse (APRN) to have a working knowledge to effectively manage them. Pruritus can be challenging, and determining the cause when possible can help tailor treatment. Hiccups and dry mouth are common; although seemingly benign, they can affect quality of life. Fever may require scheduled antipyretic treatment at end of life if it is distressing. Sleep disorders can also cause distress, but there are a variety of potential treatment options that may require titration/rotation. Appropriate assessment tools for these common symptoms are reviewed in this chapter. Nonpharmacological, pharmacological, and interventional treatments are discussed, always while emphasizing the importance of all interventions being individualized to the patient’s needs and goals of care.