Morphine and respirations - page 2
Hi, I have a question for any nurses who care for "comfort measures only" patients. These patients are not cancer patients or have pain issues. These patients are generally CVA, pneumonia etc,... Read More
Apr 13, '03...opioids use and the terminally ill patients on palliative care.
read page #17, point #5 of the pain module #2 and page #10, point #4 of the last hours module #7
hope this helps.
p.s. you'll need to have adobe acrobat reader installed in order to read the *.pdf links above. this is a free down that's available at the abode website. just click here & download it.Last edit by SKM-NURSIEPOOH on Apr 13, '03
Apr 13, '03I work in CCU, and we are seeing more and more of these type patients. We titrate for comfort using ABGs as the yardstick. Seems we never run MSO4 by itself, but with a combination of Ativan. Usually 2 to 1, and the scopolamine patch. The patient is usually on AC with a relatively high TV, increased I:E ratio, and plateau waveform, FIO2 adjusted to maintain SaO2 as high as possible at 8 bpm. Everything is then adjusted to the patient's individual comfort from ABGs. Most patients will settle at 10-12 bpm once the ABGs are in line, but we leave the ventilator at 8, assuming too much sedation and pain control if maintained there, and ABGs usually verify this.
Apr 14, '03ummm, I'm confused, vented, or non vented.... If DNR status and comfort measure order was the protocol with a drip, I would titrate to comfort, based on HR, BP, visual signs, .... look at resp. but no as a sole determinine factor....
speak with family or friends.... the patient needs a higher dose, it may speed their passing, but their comfort is a priority, and I'm worried that they may not be comfortable based on....
Apr 17, '03Originally posted by Mistynurse
I wish they would cover some of these situations in nursing school, instead of learning on the job. I am thankful there is this forum with many different nurses to give advice.
Good question though and it also brings up an ethical dilemma. Some people equate MSO4 gtt with euthanasia because you are titrating up. And it IS scary when you go up another cc an hour for comfort and the patient draws his last breath 15 minutes later. You gotta at least think, OMG, did I hasten this guy's death? So that's when I remember...despite all we do, we really don't have control as to when someone dies.
I had a patient last year; CHF, could not get her off the vent, finally trached her, still couldn't get her off the vent, got to the point where she was no longer responsive, not breathing over the vent. Family decides "it's time." Start MSO4 gtt for comfort. MD says, OK, we take her off the vent and put her on a trach collar. Guess what, she breathes. 8 bpm, same as she'd been on the vent. For several hours. It looked like the end was nowhere in sight. So we had to transfer her to oncology so I could get another patient waiting in ER. I went to see her when I got off work that AM. Still plugging along, breathing 6-8 BPM. I called oncology when I woke up that afternoon, the nurse said she'd died peacefully midmorning. Sometimes you just never know.
Apr 17, '03Originally posted by Snookie
In the state where I practice, doctors are not to give orders such as "titrate for comfort" or "morphine 2-4mg IV q2-4 hrs prn pain" -not to say that it doesn't happen. The info I received says that the MD needs to give specific guidelines on such orders for when to give the med. From what I understand orders like the one above constitute prescribing without a license on the nurses part. Anyone else with any info on this?