[AtlantaRN]

Pt takes amatadine and permax...one can cause hallucinations if you take too much, the other, you can get hallucinations if you stop abruptly. I have a patient that in the last 2 days has had decreasing level of consciousness, reaching out for things that aren't there.....Vitals are fine, sats in the high 90's...any thoughts? We stopped his sleeping pill thinking as his kidneys are slowing down that maybe it's a cumulative effect of all his meds...

Thoughts? Thanks!

linda

[doodlemom]

It sounds to me like he is dying. Was this abrupt or has he been declining?

[AtlantaRN]

he's been declining. He still isn't a DNR, i went out and gave him 20 morphine via peg and 1mg ativan, that slowed his heart rate down to 130 irregular (he was 300 when I got to the house). Oxygen is on the way for comfort. He has been declining in the last two days.

It's weird, after I left his house, I had to run up to the city to drop off some pullups for a patient and i stop at a stop light and there is one of the Neurologists from the first hospital I worked at, and she waved, rolled down the window, so I got to ask her what she thought, and she said the same thing, he's dying....... I don't know what his little wife is gonna do, she is early alzheimers- 60% mentally but 95% physically, and before this patient took a turn, he was 50% physicially and 90% mentally; together they were able to keep things together...

linda

[AtlantaRN]

update, he IS now a DNR. Daughters said "we just want him comfortable" it took 80 morphine and 4 ativan to relax the rigidity.... It was more distressing to the family than the patient. Good folks, doing a good thing.

[spaniel]

Bless you. These end stage Parkinson's cases are so very difficult. I consult in a nursing home with many folks who are aware of their decline, yet cannot seem to gain the degree of comfort your regime affords. May I ask you for any tips with pts with "Parkinson's Plus"? .. In terms of rigidity, agitation and a host of other issues such as nausea.

[AtlantaRN]

family has been giving him 40mg morphine, 2mg ativan, 2 crushed levsin via peg every 2 hours. I put each dose in one of those little glad plactic containers with the plastic lids...the family was more comfortable with me dosing out everything, than them doing it themselves...they are doing a great job. I just hope that he passes today...all of the relatives live quite a distance away, and I know the little wife can't take care of him and frankly we don't have the staff to do 24 hour care at this time...if relatives can't stay, he'll have to go inpatient.

I had titrated from 20mg every 20 minutes to get him comfortable...original order says 5mg morphine every 4 hours for breathlessness or severe pain....but he was just writhing and the look on his face was just such pain......i have to go to pharmacy this am because he will have enough meds until 2pm.

yesterday, they were still wanting to give him his peg nutrition still (even though heart rate was in the 300 range....i educated them WHY it wasn't necessary at this point...)

good folks going through a rough time.

linda

[spaniel]

You are amazing. I think this takes so much skill. We need a nurse with your expertise where I consult.

[brainnurse]

Watch out for putting scopolamine patches on PD patients. It's an anticholinergic and will worsen rigidity and drooling...may also worsen existing cognitive problems. I would ask to d/c permax and amantadine...they are for earlier stage PD management. He should be taking Sinemet 25/100 3-4 qday for dystonia and rigidity relief. Seroquel might be useful too....but NO Haldol.
I still work part time in movement disorders management...in case you hadn't guessed. lol
Brainnurse

[AtlantaRN]

he died monday morning at 4am...

linda