[Lexxie]

There is a resident who is on Hospice and actively dying. Towards the end of my shift today, he had an extreme amount of secretions that he was unable to clear by coughing. We have an order for Atropine Eye Drops, 2 drops SL q6 hrs. However the 2nd shift nurse who was taking over was adamant about NOT using it. "You have to be extremely careful when using that". Things happen, as usual, and I was unable to ask her what she meant by that. I know that Atropine affects the CNS, but the man is dying and was uncomfortable - ie: dyspnea d/t the secretions and was becoming restlessness. I know you can't read this nurse's mind, but can you help me to understand why she was being so cautios?

Thanks!

[mc3]

I've used it myself...I'm interested in the reason, too..
mc3

[HospicePalliativeRN]

I'm not sure why she would object to this treatment when someone is actively dying. We use atropine gtts quite a bit on our unit for acute episodes of secretions without any problems. For long-acting effect, we will apply a scopolamine patch at the first signs of increased secretions, but will use atropine gtts until the patch begins to take effect. Both of these medications have proven helpful in many cases of increased secretions. Hopefully she will clarify this for you so that we can understand what she meant.

Mark

[seattledeb]

Well, you do often get the rest of the anticholinergic effect with atropine-rapid heart rate,agitation. Which I mainly mention to families so that they don't over use it, I would certainly prefer those side effects than those of suctioning-every non-hospice nurse involved with a hospice patient wants to suction because we think we need to do something. I am going to tatoo "No suction" on myself! Personally, I would also rather skip the atropine unless I am in distress, too.

[txspadequeen921]

She just needed some education on the drug. I give it like water. That dosage is very low . I have patients that get 10 gtts + every 2 hours or so. She is being cautious because she is misinformed and just needs to learn about the drug and its effects on dying patients.

[Lexxie]

Thanks for your input. I thought maybe I was missing something somewhere! I won't see this nurse till next weekend to ask her what she was thinking. But I'll let you know then...

[onangelswings]

Have your local Hospice agency come in and provide an inservice on palliative care and end of life symptom management.
Atropine gtts are used routinely in hospice care to manage "terminal secretions". If this pt. was also restless and dyspneic, adjunct therapies such as Mso4 and ativan could be useful. No one should have to suffer like that because of lack of understanding of the drug.

[RN4ustat]

Actually, you don't want to initiate atropine eye gtts too early...if the patient is actively dying then it is appropriate to use to manage congestion and secretions. However, if it is started too early, it can actually cause pyschosis.

[Lexxie]

Thanks for the info. I never did see that nurse again to ask her what her misgivings were, so it shall remain a mystery!

[earle58]

Originally Posted by RN4ustat

Actually, you don't want to initiate atropine eye gtts too early...if the patient is actively dying then it is appropriate to use to manage congestion and secretions. However, if it is started too early, it can actually cause pyschosis.

secretions/congestion usually doesn't present itself til the very end.
but whatever part of the process it is, we give it/scope/levsin when the symptoms appear.
yes, these anticholinergics have many se's but it's all about prioritizing the symptomology.
managing congestion/ineff airway clearance would trump psychosis...something a little haldol would take care of.

leslie