[Bx_RN2B]

You have the right to ask questions but limit your suggestions to what you know for sure in your role as a carer. I was a CNA before I became a nurse and some of the things that the nurses and docs did seemed to go against common sense to me. Now that I am a nurse I understand how limited my knowledge was as a CNA.

This is not to say that your input is not valuable it really is but more from the role of keeping the nurse informed about changes in the patients status.

[earle58]

Originally Posted by mez1703

I will get the full list meds/dosages.

As a carer, do i have the right to ask questions and make suggestions?

when you say "carer", are you a nurse?

also, another commonly used drug is thorazine.
thorazine can be extremely helpful in addressing dyspnea, delirium, anxiety and nausea.

when it comes to the terminal stage, the main focus is on managing pain, dyspnea, secretions and nausea/vomiting.
the only reason i mentioned something for bowels, was when you mentioned her 'tummy' w/subsequent vomiting.
but now it sounds more from ascites, ? uremia and the buildup of toxins in her system.
maybe an enema at this point, would be helpful, vs a regimen.
it's mostly about keeping it simple yet aggressive.
even though sudden deaths are quite normal, we want to do everything possible to control the dyspnea...
which is the biggest challenge.

blessings to all.

leslie

[earle58]

sev'l links similiar to the following, are readily available.
my point is, end stage chf is not the same as the terminal phase.
especially when hepatic and renal failure sets in.
people can live w/end stage for yrs.
it is when they become totally bedridden, and comorbidities are dominating precious time left, focus should be on abating symptoms.
chf remains poorly treated, despite meds that prolong survival.
careful consideration needs to be given re what meds to continue, or not.

Dying from heart failure: lessons from palliative care

"Despite the wealth of therapeutic advances, quality of life in chronic heart failure is poor and discomfort and distress often worse than in cancer."

http://www.pubmedcentral.nih.gov/art...?artid=1114039

leslie

[mez1703]

Ok - her medications are as follows;
Ordine - as required (morphine hydrochloride)
Kapanol - 2 per day (morphine sulphate - sustained release)

Breakfast
Cartia 100mg x 1
Atacand 8mg x 2
Frusemide 40mg x 1
Eutroxig 100mg x 1
Sertraline 50mg x 1
Carzedilol 6.25mg x 1

Dinner
Carzedilol 6.25mg x 1

Bedtime
Temazipan 10mg x 2

There were meds, but dr has stopped them.

She is confined to a chair and bed.

[mez1703]

I forgot to add that she is on oxygen 24/7

[earle58]

Originally Posted by mez1703

Ok - her medications are as follows;
Ordine - as required (morphine hydrochloride)
Kapanol - 2 per day (morphine sulphate - sustained release)

Breakfast
Cartia 100mg x 1
Atacand 8mg x 2
Frusemide 40mg x 1
Eutroxig 100mg x 1
Sertraline 50mg x 1
Carzedilol 6.25mg x 1

Dinner
Carzedilol 6.25mg x 1

Bedtime
Temazipan 10mg x 2

There were meds, but dr has stopped them.

She is confined to a chair and bed.

ordine is not morphine.
it is an antihistamine.

she needs something for breakthrough pain.
and for n/v, constipation
and for anxiety.

leslie

[shrinky]

We have recently used nebulized Lasix since, it is not absorbed as much as oral, which might relieve some of the congestion. I agree with the use of Morphine and Ativan in this case. She most likely will need to be very sedated near the end. Good luck and thank you for all you are doing and for caring.

[marachne]

[quote=earle58;2919837]ordine is not morphine.
it is an antihistamine.

OK, I admit, I'd never heard of ordine, nor had I much familiarity with morphine hydrochloride -- always used MS04.

So, the internets are our friend, and I went searching. I finally found this which does link morphine hydrochloride to the brand name ordine. Therefore I have to conclude Ordine is a pain medication...but I'm willing to be set right.

It seems to be much more common in the UK and Australia. The use of the word "carer" also makes me think non-US.

[earle58]

Originally Posted by marachne

OK, I admit, I'd never heard of ordine, nor had I much familiarity with morphine hydrochloride -- always used MS04.

So, the internets are our friend, and I went searching. I finally found this which does link morphine hydrochloride to the brand name ordine. Therefore I have to conclude Ordine is a pain medication...but I'm willing to be set right.

It seems to be much more common in the UK and Australia. The use of the word "carer" also makes me think non-US.

oh my goodness...
you're right.
i don't know what i was thinking.
my apologies.

leslie

[earle58]

mez, if she is still getting out of bed to a chair, then to me, it would be realistic to share your concerns about her constipation.
some may think i'm obsessing, but truly, i'm not.
addressing this can indeed, alleviate some if not much of her pain.

if she is complaining of breathlessness, air hunger, she needs to have her morphine increased.
and getting her some ativan or something for anxiety, will also be of tremendous value.

i need to believe her hospice nurses know this?

and, you are a very special person to be so concerned.
thank you.

leslie