Morphine doses while dying?

[Medsurg Mama]

I know in hospice that patients are able to receive quite a bit of morphine during the dying process, but what is the normal dose at the care facility where you work? My hospital had a recent pt that was dying d/t hem. stroke and was already passing quickly when the family went above the nurses head and called MD at home, who then came in and gave nurse verbal order for morphine 4mg q10 min for pain prn. Aside from the fact that this pt had NO s/s of pain whatsoever, the MD said to nurse (with other nurses present) "the family is tired, just give it every 10 minutes unitil respirations stop". Very thankful I was not the nurse but this has really bothered a lot of us, and I just wanted to know if anyone has had a similar order?

[patwil73]

Babs0512,

I think in the end we are essentially in agreement - perhaps just using different words to express the same thing. From your passion describing how you care for your patients I would have no qualms having you as my nurse.

My sincerest condolences on your mother, that is a decision I would never wish on anyone. For all you lurkers out there, please never hesitate to talk with family about their wishes and encourage them to fill out advance directives.

Pat

[Xbox Live Addict]

Pat: I stand by what I said, "I would not medicate the patient just to keep the family happy". I would medicate the patient if the patient needed the medication.

The family had made a request that morning, they didn't want any sedating medications giving to their father after 1200, as they wanted him awake and coherent when they came in that afternoon. I knew their wishes. I tried not to medicate their father, but he became so anxious, the vent alarms wouldn't stop sounding, and his sat's began to drop. I found myself with a choice, care for my patient and sedate him, he was clearly frantic and it was affecting the vents ability to respire him, not to mention he became tachycardia and developed an elevated BP. He was able to tell me by shaking his head "no", that he was not in pain, he simply didn't like the feeling of the ET tube and couldn't just relax and allow the vent to do it's job.

I read through my orders, and no where did I see the order "Hold medication when the family reqests it." While I tried to abide their wishes, I simply could not allow my patient to suffer - and he was suffering - any longer. I gave him the ativan and he relaxed, his sat improved, his HR normalized as did his BP. Not 5 minutes after I gave it his son showed up, and boy was he peeved that his dad was sedated. He complained to the nurse manager and I got pulled into the office. I explained the situation, and stated "I would make the same decision again - I'm here for my patient FIRST." I had documented well. I had done nothing wrong. And the family was educated as to why it was necessary to medicate their father. The son was still peeved, but then he wasn't my primary concern. He was tertiary at best.

Blessings

"Holding medication when the family requests it" would also be an unethical physician order. For all that I am against literally drowning a person in medication just to make a family happy, if the patient is distressing, then it's past time for the medication. If the patient needs the medication, they need it, family be damned. What kind of "quality" time was the son expecting if his poor father was in that kind of shape and so anxious he was developing tachycardia?

[Xbox Live Addict]

i personally feel scare when i here morphine. when i was a student i learn that morphine ease dying pt pain and also learn it also depresses the pt resp so then why are still using morphine as a pain med. i will rather the doctor give it himself.:loveya:

during my clinical years at school i remember the patient son did not want the dad to take the prescribe morphine per his request but according to the order the patient was to take the morphine every 2 to 4hour if you do not give the med you will be held relable med error in this case i had no choice butto give the med to help with the pain.

Morphine, when used correctly, is one of the safest drugs there is. It does not stress your liver the way Tylenol does. It is not addictive in the presence of severe pain. Even the effect of respiratory depression can be utilitzed beneficially; I have taken care of plenty of patients with respiratory illness in whom morphine was actually prescribed to improve breathing patterns from rapid, shallow, ineffectual respiration to deeper, more comfortable respiratory patterns with less use of accessory muscles.

Any medication is dangerous if not used correctly.