On friday, I was taking care of a very elderly person, who was knocking on death's door. Pts respirations were 5 per minute. Pt has had these breathing episodes a few times over the last few days. Family stated pt was in pain, and that I should give pt a pain shot, since it was time. (Dilaudid, 1mg IM)
Patient was not able to communicate if they were in pain. Pt was not showing any outward signs of being in pain, but I also had the feeling that pt was either in pain, or very anxious. It was hard to tell. It was my gut feeling that pt was not comfortable. The patient has been receiving the same dosage for several weeks. There was not an increase in the dosage or frequency of the med.
I explained to family, that if I were to give the Dilaudid, pt may stop breathing. It was not absolute, but there was a chance.
I can not give more details about the situation, but the family was TOO okay with this. They actually made a comment about me euthanizing the pt. I can not say the actual comment they made, since I do not want to give too much info.
The primary doc was aware of the situation, and wanted me to give the Dilaudid. He even came to the floor, since I called him several times about it.
What would you have done?
I would have given it. When my grandmother had terminal cancer (pancreatic, liver, and lung) and lost consciousness near then end, she was still moaning whenever she was moved and we could tell she was still in pain. The doctors and nurses informed my family that the amount of morphine they might have to give to make her comfortable might cause respiratory depression. We just said to give whatever she needed so she wasn't in any pain. That was the entire conversation. Nothing about euthenasia, nothing about misery, nothing like that. Just a mutual agreement that pain management was the number one priority in this case, period.
I think you did the right thing. I do understand that the comments from the family made you uncomfortable, though, and I can imagine why. Talk to your supervisor about this case - for one thing, it'll help to talk about it and debrief, and for another, if there is any ethical committee action that needs to take place (to help in future situations like this) then your supervisor should be the one to set up that kind of thing.
Last edit by Gompers on Mar 5, '07