MORPHINE and Dying Patients - page 14

Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.... Read More

  1. by   marinemom07
    In the past week I have cared for two end of life patients. One had a MSO4 drip and the other Versed and Fentanyl. (I work in ICU) As long as you are documenting your signs and symptoms for titrating there is no reason on this earth that these patients should not be comfortable! It is my duty and my privledge to make their last moments on earth as comfortable as possible and to make their passing easier on the family at the bedside.
    On a personal level my Dad died of CHF and renal failure. His last three days of life were made tolerable by MSO4. He died laying flat in bed and comfortable instead of gasping for air and drowning!
  2. by   nuangel1
    i have read this whole thread .i have been an icu er and floor nurse.i have been a nurse 21 yrs .i have been in situations where pt's were terminal from 1 thing or another some on morphine or other pain med/sedation and others that should have been .i have always believed we have a duty to treat pain .and that all pts should be as comfortable as poss .people should be able to die with dignity and peace .this allows the family to grieve and not remember their loved one dying in pain and suffering .i never felt bad about titrating meds as long as i documented .but my recent experience as a daughter really drove this home.

    i was very grateful recently for the nurses my mom had both in ed ,floor and icu.after being dx with uti ,pneumonia, sepsis and cva ,i made the very difficult decision to make my mom a no code -dnr/dni .when it became apparent -labored breathing ,high fevers etc that she was distressedand was dying i made my mom a cmo .no one from the drs to the nurses questioned my decision they made her comfortable titrating the morphine as needed .i was allowed to stay with my mom throughout with my family and friends coming and going .i wanted her last moments to be peaceful and painfree and thanks to the dedicated staff i knew they were .she passed quietly with us at her bedside .

    nurses i thank you for your compassion.
    Last edit by nuangel1 on Jan 11, '08
  3. by   Sabby_NC
    Quote from nuangel1
    i have read this whole thread .i have been an icu er and floor nurse.i have been a nurse 21 yrs .i have been in situations where pt's were terminal from 1 thing or another some on morphine or other pain med/sedation and others that should have been .i have always believed we have a duty to treat pain .and that all pts should be as comfortable as poss .people should be able to die with dignity and peace .this allows the family to grieve and not remember their loved one dying in pain and suffering .i never felt bad about titrating meds as long as i documented .but my recent experience as a daughter really drove this home.

    i was very grateful recently for the nurses my mom had both in ed ,floor and icu.after being dx with uti ,pneumonia, sepsis and cva ,i made the very difficult decision to make my mom a no code -dnr/dni .when it became apparent -labored breathing ,high fevers etc that she was distressedand was dying i made my mom a cmo .no one from the drs to the nurses questioned my decision they made her comfortable titrating the morphine as needed .i was allowed to stay with my mom throughout with my family and friends coming and going .i wanted her last moments to be peaceful and painfree and thanks to the dedicated staff i knew they were .she passed quietly with us at her bedside .

    nurses i thank you for your compassion.
    Hugs to you as one that experienced similar. Hang in there.
  4. by   elizabells
    My grandfather passed away in March from metastatic melanoma. He died at home, with hospice care. My father is a, well, I guess sort of like an unlicensed NA in a hospice back home, as a volunteer, and he was in charge of giving the meds. The hospice provided us with MSO4 gel, Haldol gel, and Ativan liquid. When it got to the end, I was kept out of the room when he was given his meds, just in case a question was raised, because I was the one who would theoretically have known how much was too much. Leaving aside the fact that a) who would question? My grandmother was fully supportive of whatever my father and the hospice NP felt was appropriate and b) I work with babies, so I wouldn't actually know how much was too much, but had I been asked, I would have given him however large a dose it took to relieve his pain. The tumors on his legs were so bad they bled and wept lymph to the point that my grandmother had to buy a new bed. Whatever it took, I would have given it.

    I feel VERY strongly about appropriate pain relief for ALL patients. I'm currently part of an initiative on my unit to reform the way we medicate our babies, as we are YEARS behind evidence-based practice on the subject.
  5. by   safta24
    Thank you for reinforcing the comfort of hearing how morphine used liberally will help patients at the end of their life.
    Safta24
  6. by   ♪♫ in my ♥
    This thread caught my eye because my dad is in his last days or hours and suffering from bladder cancer, emphysema, and dementia. He is at home in the care of a loving family and an excellent hospice nurse.

    We've just been addressing this issue in his case and we're in unanimous agreement that his comfort in these last days or hours is paramount. The morphine not only controls his pain, it eliminates his weak, ineffective cough -- both of which help him relax.

    Second only to his comfort is keeping my diabetic step-mom healthy. The morphine use bears upon that because keeping him comfortable keeps him quiet and peaceful; keeping him quiet and peaceful lowers her stress level which in turn allows her to sleep some and to better control her blood sugar.

    The aggressive use of morphine is not going to change the outcome, perhaps only the timing.

    I will not stand by and watch my father needlessly suffer during these last days and hours of his life. Neither will I risk my step-mom's health. The medications will be used at whatever levels are necessary for them to be effective. There's no point to buying time.

    For what it's worth, I'm an evangelical, Bible-believing Christian. I believe that use of the morphine to make my dad comfortable is an act of mercy even if it shortens his time with us (which he really isn't, anyway).

    Just the opinion of one guy who's seen a grandfather, a mother, and now a father succumb to cancer.
  7. by   twotrees2
    Quote from constantlylearning
    Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.
    do not have any problem giving morphine on a scheduled bassis to keep the patienmt comfortable. one of the night shifters who would come in and several times found a patient who had been dying dead 0 and id feel horrible cause id checked em but he dies between the checks and i wuold always offer to stay and helpbut he would just say its ok i got it - and told me not to feel bad- i "killed em with kindness" he was just trying to cheer me up and honeslty it workd and i felt better and now i dont feel bad. i did though the first few times it happened - i am sure many folks need time to see what NOT giving it vs giving it is like to realize that it is ok.
  8. by   Jo Dirt
    I watched a man die from lung cancer when I was a young CNA. They were giving him Lortab for comfort. He also had staph. He would lay in the bed, miserable. One night he said he wished he could go ahead an die but he guessed he was going to have to keep laying there suffering. I felt so bad for him. He lived for months like that.

    There was no need for that. He should have been treated with the respect he deserved.
  9. by   urnursetoday
    I do agree in providing comfort even if the out come is " death" . I felt that way during my mother's passing and I feel this way while working as a hospice nurse. Many are not comfortable with medicating actively dying patients. They believe they will "kill" the patient. Little do they realize that it is the disease process that "IS" killing the patient and causing pain that put their( nurses )last tooth ache or broken limb or child birth to shame. Fear + pain level 10/10. I am not there for the nurses that shy away from hospice although I do always need their support; I am there, for the patient . I might add I am not here to judge those who are not comfortable with hospice . Many nurses have many talents.
    Last edit by urnursetoday on Oct 5, '08 : Reason: miss spelled word
  10. by   uscstu4lfe
    One of my nursing instructors from school, a Nurse Practitioner, said that morphine hastens death. However, he said to look at it this way: would you rather be loaded up on morphine and die in 3 days, or have no morphine and be in pain and die in 5 days?
  11. by   ShayRN
    Quote from uscstu4lfe
    One of my nursing instructors from school, a Nurse Practitioner, said that morphine hastens death.
    AAAHHHHHHHH
  12. by   leslie :-D
    Quote from uscstu4lfe
    One of my nursing instructors from school, a Nurse Practitioner, said that morphine hastens death. However, he said to look at it this way: would you rather be loaded up on morphine and die in 3 days, or have no morphine and be in pain and die in 5 days?
    i find it more realistic to be on morphine and die in 3 days, or no morphine and linger in excruciating pain for 3 wks.

    leslie
  13. by   Iam46yearsold
    Give me morphine, dilaudid, marijuana, anything that eases my suffering in my final days.

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