[captain morgan]

I have started a new job as a hospice nurse and need help on symptom management. Esp. pain. I have a pt who has dx: lung CA who is rating his pain 10+, yet he is sitting up and talking with me???? He is on quite a lot of pain meds - morphine, AHBV suppositories, haldol, xanax. What am I going to do when he gets worse??? I feel like I'm not doing much for him when I check in on him, so I was wondering if anyone has any advice for an old nurse starting a new avenue of nursing??
Thanks so much.

[river1951]

People who have pain can have high pain and still talk- some folks will always rate their pain as a 10.
But we still must treat- I would use immediate release morphine elixir and have them give him enough to knock the pain back- get a range from the doc of 0.5 to 2 ml (10-40mg) orally every hour. Total the dose for a day, divide by 2, and voila you have your long acting morphine dose for every 12 hours.
That is if he (she) has pain uncomplictated by bone pain or nerve pain- for those adjuvant meds are given in addition to the morphine- for bone pain you can give any anti inflammatory if tolerated (if patient is eating), and for nerve pain you can use valproic acid (Depakoate) or amitryptilline or neurontin.
Get a good symptom mgt book.
And realize that sometimes patients have unresolved psychological issues, till those are relieved sometimes nothing you can do will matter..
And welcome, it's a great place to do good things!
River

[Hospice Nurse LPN]

Does your pt have history of alcohol or drug (legal or illegal) use? This is something I always ask.....not to judge, but because when folks have a history pain will be harder to manage. And don't forget "spiritual pain". I totally agree with river1951 about everything suggested.

[aimeee]

Originally Posted by Hospice Nurse LPN

Does your pt have history of alcohol or drug (legal or illegal) use? This is something I always ask.....not to judge, but because when folks have a history pain will be harder to manage. And don't forget "spiritual pain". I totally agree with river1951 about everything suggested.

People who have a history of drug or alcohol use often take much larger doses to achieve the same results. They may also manifest their "spiritual pain" in physical symptoms. It doesn't make it any less real to them, but it does make it more difficult to achieve comfort for them.

Everybody has their favorite, but this little book packs a lot of good information into a fairly small size. Our medical director recommended it and I have found it to be a good resource for thinking through issues:

Symptom Management Algorithms by Linda Wrede-Seaman

[EmptytheBoat]

Don't wait until he gets worse, titrate medication until you get your
patient comfortable; and let your total assessment determine his comfort
level, use your education/experience.

[captain morgan]

Thanks all you hospice guru's....I did up the morphine and he is doing much better. He has even been able to putt around in his garden a bit on good days. And I will be investing in a good symptom mgt book.... thanks again and God bless.

[RNDYN2CU]

Originally Posted by captain morgan

I have started a new job as a hospice nurse and need help on symptom management. Esp. pain. I have a pt who has dx: lung CA who is rating his pain 10+, yet he is sitting up and talking with me???? He is on quite a lot of pain meds - morphine, AHBV suppositories, haldol, xanax. What am I going to do when he gets worse??? I feel like I'm not doing much for him when I check in on him, so I was wondering if anyone has any advice for an old nurse starting a new avenue of nursing??
Thanks so much.

Dilaudid via CADD pump for pain mngmt may work...