MORPHINE and Dying Patients - page 8

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

  1. by   cmo421
    Quote from suespets
    i'm talking about unconscious pt,s no jaw clenching, aggitation nor grimaceing. Thank you for the studies info on morpine and cancer pain, it helps! i think the concensus here is that unconscious pts are always in pain.It seems a heck of a lot of ms04 is given by other nurses than the orders i've followed through on, i guess the lord won't hold it against me if I believe i'm assisting someone in dying but don't know it for sure.my apologies to whomever's sensibilities ive offended by not proofreading;my emotions re: the message content,was my priority. New thread idea....What is the difference between dr.kevorkian and ms04 orders for dying pt's?

    You might consider a path that does not involve ease of death and comfort of pt and family. Just an FYI. A year or so ago, a California family sued the doc who cared for their family member for not easing their pain, and they won millions!
  2. by   classicdame
    They will die from the condition whether you give them morphine or not. Your intent is to not have them die in agony.
  3. by   RedWeasel
    my dad died in oct. in a hospital, on a cardiac floor with copd i guess. anyway, his lasix had just been increased and his ankles were looking better. well one morning my mom goes up to the floor and finds him in distress (was no one working with my dad? i thought). she calls me in a panic and said the nurse refused to raise his oxygen above 2 liters all night. (what?!?) anyway, i tell her to put a sign next to the o2 not to lower below 3 or 4 at least, to raise it and if there is trouble to call the nsg super, and that i am on the way (the day before the dr and sw (worked in hospice many years)had told us if he went home he'd be on 5 or 6l). anyway i am on my way there in my pjs in a car that had died the day before, praying to god just to get me there to get my eyeballs on this 'nurse.' i get there his ankles are good but he has been struggling and the resp therapist is in there and he is on 6l now, but still has a lot of catching up to do. my mom tells me the following not necessarily in this order: i did the sign and the rn came in and ripped it off the wall and said "who put this up there?! the doctor would go through the roof if he saw this there." my mom tells me the rn told her "he cant have his o2 above 2l due to some (the 02) drive?," i said yes if he was just diagnosed with copd.!!!! helllloooo lungs filled with fluid/lower surface area to accept 02, needs higher concentration to be of use to my dad. yes it was very frustrating. she tells me his pulse ox was 80 to 75 % and he was struggling and the rn told my mom, "you see hes fine, hes fine." and my mom is very accurate and if she said the rn said that, she said that. (my biggest problem here is that the rn was practicing medicine-we as nurses are to treat symptoms. my dad was in distress and she did nothing. my dad was under a hospitalist dr-who is on campus at all times. all it would have taken was a call a freaking phone call) the nurse wanted to call the doc to do abgs. (at the desk the sw overheard and said "no we are not doing that to him." she is an angel) anyway mom says "we are getting another nurse. the aide said to me after the sign thing, 'you know you can request another nurse'after the rn left the room. i asked my mom if she did and she said "no before i could the resp therapist came in and said 'you are getting another nurse.' and then the resp therapist kind of gave my mom a knowing look like, yea we know she sucks.' anyway then the room was full of pp, drs (prob when she called to get the abgs ordered he saw how crazy she was-the doc was my dads fav and he loved my dad-and you just dont upset him, sw, chaplain, rts aides, new nurse (excellent) and then i see the other nurse peering in the room like whats going on? the problem here is that it turns out it was his last lucid day talking and alert. the lasix was working, but due to the distress the dr orders 1mg of morphine q hr, per pca. this was yes a godsend. he who never wanted meds woke up later -twice-and said what did they give me? that was good stuff. anyway the next day he woke up a few times and said "goodbye" and "bye". the next day he couldnt speak. we asked as we left that night if he wanted us to stay, he just looked at us (maybe he stroked?) anyway, i wanted to stay but since my car was down i decided it was unfair to my mom to make her stay with me and my brother was on his way into town to see dad. so i drove her home in her car and planned to return at 0200. we got a call at 0110 that his bp was dropping, i said well be there in 10 minutes. he died as we walked in the room. i cant get that out of my head. anyway i just feel cheated because yes i wanted the morphine, but feel it could have been put off if he had had the 02 he needed and not been in distress due to that nurse, since the lasix was doing good. i just feel like the morphine should not have been needed yet, and his last lucid day with us (morphine knocked him out and built up in him) was a struggle. that is my personal take on morphine, but dont get me wrong, if i am gonna go, or more importantly my dad, it couldnt have been calmer and more comfortable. sorry for being so long, and ill wrote, (and i have an english degree). yikes.
  4. by   RedWeasel
    I posted above, and in response to the being snowed, we were going to have it pared the next day, but he died. The reason he got the morphine was because of the 02 ordeal. He was in distress cuz she wouldnt raise it above 2L when he should have been at 5 -but the lasix was working, and we just wondered if he would do okay without it so much, dont fault us for wanting to have quality time with him before he died, if he was still in distress, well then fire up that PCA pump again...no problem, but he had been lucid and talking, but in distress, before it was started. We just wanted to be able to speak to him...and have a PROper goodbye, that is all. See it from our side. We feel cheated. -Dont get me wrong though, I know what you mean, a pt in pain, they don't want pain meds, but the fam calls you all the time if the pt crosses their eyes. "Why is he doing that? Can you make him stop etc.?" Good Lord, if you want us to treat them, let us treat them, cant have it both ways.
  5. by   SuesquatchRN
    {{{{{silvergirl**********

    Your dad was lucky to have you fighting for him. And he got to say goodbye, anbd that "that was good stuff."

    A little more time would have been good. But his last days were with you all, and pain free.

  6. by   GadgetRN71
    Just because someone is unconscious doesn't mean they don't feel pain. It just means that they have a difficult time expressing it. There have been cases of people under general anesthesia who appeared to be unconscious but were feeling everything. Sometimes when we are operating, it looks as though the patient is asleep, they're intubated, and when the surgeon goes to make incision, they squirm or jump(one guy tried to get up off of the table). There have been documented cases of people in comas who were aware of their surroundings. I still say that I'd rather have a patient die calmly, in comfort. that to me is dying with dignity. We're talking about the terminally ill. You denying them pain meds isn't going to cure them or win them any spiritual brownie points. It's just going to cause them to die in agony and that is something I wouldn't wish on anyone.
  7. by   Scrubby
    As nurses we need to advocate for our patients, and yes even put our own personal feelings aside to give them the best care possible. It's not about you, it's about making your patients as comfortable as possible. I would hate to be dying and having my pain relief denied because my nurse felt uncomfortable giving me pain relief due to religious beliefs etc.

    When I worked in ICU I saw a lot of patients 'suffering from horrific injuries and dying made comfortable'. One of the practices was to give the maximum amount of morphine and to position the patients with the head tilted down. Yes this probably sped up the process but i have no problem with that.
  8. by   suespets
    silvergirl; I don't blane you at all.seeing whay happened w/ your dad, kudos to you! Scrubby thanks for your input oops, forgot to proof read,mea culpa! I remember how my dad was crawling around in his hospital bed, looking for 02,stuperously grabbing at call light cord,thinking it was 02, trying to put it in his nose. He was copd,so dr. was only giving 2l. I went to the nurse & told her he needed more liters,she told me I should advocate for him(dad)and insist dr. order higher. I told the Dr.";you asked me for a comfort order,now give him comfort;increase the o2,"seeings he was obviously uncomfortable. dr did increase liters/per hr.
    Last edit by suespets on Nov 28, '07 : Reason: clarification
  9. by   blueheaven
    Do you know it was the morphine that caused him to be "knocked out???" I'm not trying to be devil's advocate here but also a little understanding of CO2 narcosis would be appropriate. Without ABGs etc, you would not be able to tell where he was at with his CO2. Increasing the O2 or placing him on Bipap may or may not have prolonged his life for a bit. I also realize you are still in the grieving process and looking back at things, etc. I watched my dad die with COPD/Cor pulmonale and he made the brave choice to be DNR/DNI. My dad only lived 4 days after admission to the hospital. First 2 days he was lucid (majority of time) and lthe 3rd day he was "in and out" on the 4th day he would occ. wake up and immediately drift back off and he passed very quietly that evening.
  10. by   RedWeasel
    Quote from blueheaven
    Do you know it was the morphine that caused him to be "knocked out???" I'm not trying to be devil's advocate here but also a little understanding of CO2 narcosis would be appropriate. Without ABGs etc, you would not be able to tell where he was at with his CO2. Increasing the O2 or placing him on Bipap may or may not have prolonged his life for a bit. I also realize you are still in the grieving process and looking back at things, etc. I watched my dad die with COPD/Cor pulmonale and he made the brave choice to be DNR/DNI. My dad only lived 4 days after admission to the hospital. First 2 days he was lucid (majority of time) and lthe 3rd day he was "in and out" on the 4th day he would occ. wake up and immediately drift back off and he passed very quietly that evening.
    My dad was DNR. He was only on 6 liters for 1/2 hour to raise the 70%sp02 to 93%, they put him at 3L after they started the morphine, he stayed at 3 L till he died-being sedated and all he didn't need it higher-he was calm. My dad would not take ANY pain meds, ever, in his life. Not even tylenol. So yes the morphine would have sedated him severly. I am not saying he wasn't dying. I am saying that to do ABGs on a pt who had been refused his 3-4 L of 02 (and if you KNOW you are being refused that, would that not make you more anxious, plus knowing the RN was not calling your DOc? More anxiety) is cruel, knowing he had been a DNR. They had, even after the morphine started, DC'd his accuchecks. We had no unrealistic expectations. For all I know-he stroked and this killed him-who knows? Like I said He had been deprived for like 12 hours of 02 while the increased lasix had started working, that takes a toll. I am not saying he wouldn't have died anyway. And really what does it matter if it was the COPD or the Morphine-not my point--I don't feel the morphine necessarily sped up the dying process, it just was started I feel sooner than needed and cheated us out of our real last goodbyes. Again, I wouldn't have changed his having the morphine now, I just wish he had had his 02, let the higher dose of lasix work and if it hadn't then been able to get the rest of my bros here to say goodbye in time. Point was it was started sooner than needed (I feel) and he ended up being very sedated just after being unable to breathe. His last lucid moments were fighting for air - or at least knowing he had been refused 02 that he needed. And we never had complained about his nurse that night. Not yet anyway. But she was fired over it I heard, so I feel I am in the right about much of what was said. Just my own opinion, since I was there. I guess, yes I am still grieving, esp this being his birthday, so I normally don't lash out at someone, but really why must you even ask that question? I wasn't downing morphine or its use--just that it sedated him.... Plus he only became a COPD er after bronchitis (acute) in sept--and refused ATBs--which put him in the hospital. They mistakenly, while in the hospital that time reduced his lasix to 40mg (form 80) and sent him home on that. He had CONGESTIVE heart failure, and this is really what they were treating at the time, from the Xray they had taken--at least that is what the doc said--stage 4 CHF. Anyway, he starts taking just 40mg of lasix, and yes ended up back in the hospital....whatever, anyway, YES the morphine sedated him
    Last edit by RedWeasel on Nov 30, '07
  11. by   SuesquatchRN
    Oh, silvergirl, I'm so sorry for what your dad went through, and that his birthday has coincided with this thread to dredge it all up.

    Honestly, I think that blueheaven is still tring to make sense out of her own father's death in similar circumstances. I didn't read any criticism into her comment.

    I just wish that we as a society would learn to accept the inevitability of death. I have seen more unrealistic families - and health care workers, nurses and physicians included ....
  12. by   RedWeasel
    Quote from Suesquatch
    Oh, silvergirl, I'm so sorry for what your dad went through, and that his birthday has coincided with this thread to dredge it all up.

    Honestly, I think that blueheaven is still tring to make sense out of her own father's death in similar circumstances. I didn't read any criticism into her comment.

    I just wish that we as a society would learn to accept the inevitability of death. I have seen more unrealistic families - and health care workers, nurses and physicians included ....
    I know she was not being critical and I am sorry, its just that I dont know....I really dont know...I should just go to bed huh? Sorry.
  13. by   RedWeasel
    sorry if I went on too long, I guess it is still raw. Guess I need a break from allnurses huh?
    Last edit by RedWeasel on Nov 30, '07 : Reason: wrong post

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