0700 handoff. Mr. K, 78, has stage IV non-small-cell lung cancer and advanced COPD and has been on the inpatient hospice unit for five days for refractory dyspnea. His plan is comfort focused, and a DNR/DNI order is on file. His son has asked to be called if signs suggest that death may be near. Throughout this stay he has had pursed-lip breathing, clubbed fingernails, and respirations of 28/min, and his saturations have ranged from 84 to 88 percent. This morning his breathing is labored with a new Cheyne-Stokes pattern, and SpO2 is 86 percent on his usual 4 L/min. His BP is 96/58, compared with 112/70 yesterday, and his knees are mottled. He is arousable only to firm voice; he has received no lorazepam for two days. With a small sip of water he coughs and pockets fluid in his cheek. He intermittently grimaces and reaches into the air. New pooled upper-airway secretions are audible. Temperature is 37.2 C, ankle edema is unchanged at 1+, and his last bowel movement was two days ago; his abdomen is soft and nondistended, and a bladder scan shows 90 mL.
0700交班。K先生，78歲，患有第四期非小細胞肺癌和晚期慢性阻塞性肺病，因頑固性呼吸困難已在住院安寧病房住了五天。他的照護計畫以舒適為導向，並已備妥不施行心肺復甦術/不插管醫囑。他的兒子曾要求，如果出現瀕死跡象，請通知他。在這次住院期間，他一直有噘嘴呼吸、杵狀指和呼吸速率28次/分，血氧飽和度介於84%至88%之間。今天早上，他的呼吸費力，出現了新出現的陳施氏呼吸模式，並且在常規4公升/分的氧氣下，血氧飽和度86%。他的血壓96/58，與昨天112/70相比，膝蓋出現斑駁。他只能對堅定的聲音有反應；他已經兩天沒有服用勞拉西泮。喝一小口水時，他咳嗽並將液體含在臉頰。他間歇性地面部扭曲並伸手到空中。可聽到新的上呼吸道分泌物積聚。體溫37.2°C，踝部水腫仍為1+，且上次排便在兩天前；他的腹部柔軟無膨脹，膀胱掃描顯示90毫升。