Morphine doses while dying?

  1. 4 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?
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  3. Visit  Medsurg Mama profile page

    About Medsurg Mama

    Medsurg Mama has '10' year(s) of experience. From 'Indiana'; Joined Mar '06; Posts: 6; Likes: 4.

    50 Comments so far...

  4. Visit  DroogieRN profile page
    0
    I'm only in my first semester of my program, but I'm thinking that if the doctor wanted the patient to have that much morphine, the doctor would have to administer it personally. No way would I do it.
  5. Visit  Xbox Live Addict profile page
    2
    Quote from 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?
    I have personally been in situations where the physician raised the order for Roxanol at the will of the dying patient's family, even though the patient was respiring easily and sleeping well. Not only was I extremely uncomfortable with it, but the hospice was also balking at this. I asked the DON, and was granted permission, to withdraw myself from this resident's care.
    Dolce and leslie :-D like this.
  6. Visit  NursKris82 profile page
    1
    Firstly, just because a patient has no s/sx of pain, doesn't mean their not in it, especially if they're dying and may not be able to express it.

    That said- that seems like an extremely high dose with that frequency and also given for the wrong reasons. I would not do it. A hospice nurse might know better.
    racing-mom4 likes this.
  7. Visit  loriangel14 profile page
    0
    We handle a fair bit of palliative pts where I work and the standard order we get for morphine is 2-10 mg q15min.I did have one pt that was getting 5mg every 20-30 min. at the end.
  8. Visit  pricklypear profile page
    29
    In the last few minutes or hours of someone's life? Why is it such a big deal? Does someone really need to be exhibiting "signs and symptoms" of pain (as they are dying) to be in pain?? Do you want them to wake up and tell you? Are you afraid you might kill the patient? I'm having a really hard time understanding questions and attitudes like this. Some critical thinking is in order.

    Morphine has other benefits and uses besides pain relief. One of the biggies is relieving "air hunger" that occurs due to inadequate respiration and low O2 sats during the dying process. Air hunger is the feeling of suffocation that you may feel while you're under water too long. Is that how you want to spend your last few hours?

    What a great way to increase the discomfort of the family and possibly the patient as well as make the death of a loved-one even more difficult and infused with negativity than it already may be.
    Castymiss, Kitty-RN, MrsMommaRN, and 26 others like this.
  9. Visit  Blee O'Myacin profile page
    12
    I never had a dosage order with comfort care. It was always "titrate for patient's comfort"., not ours. People take their own time when being born and when dying. I'd rather err on the higher dosage end than risk having a dying patient suffer needlessly under my care.

    Blee
    Kitty-RN, MrsMommaRN, mom4josh, and 9 others like this.
  10. Visit  jetsetter profile page
    12
    My hats off to prickly pear for putting into words my sentiments so eloquently.
    Our floor deals with alot of end of life pts, and I also hear alot of negativity from other staff. I fully believe in supporting the pt and families wishes as much as possible. Who's to decide how much pain med is "too much" or "too little"? How can we possibly know the pt better than the family?
    As long as the immediate family is in agreement, I believe in supporting them as much as possible.
  11. Visit  uscstu4lfe profile page
    4
    i want to be fully loaded on morphine if i have ever have end of life care. i never, ever want to experience that "air hunger" (aka suffocation) feeling, it's the worse feeling to have!
    mom4josh, skittlebear, racing-mom4, and 1 other like this.
  12. Visit  morte profile page
    6
    Quote from pricklypear
    In the last few minutes or hours of someone's life? Why is it such a big deal? Does someone really need to be exhibiting "signs and symptoms" of pain (as they are dying) to be in pain?? Do you want them to wake up and tell you? Are you afraid you might kill the patient? I'm having a really hard time understanding questions and attitudes like this. Some critical thinking is in order.

    Morphine has other benefits and uses besides pain relief. One of the biggies is relieving "air hunger" that occurs due to inadequate respiration and low O2 sats during the dying process. Air hunger is the feeling of suffocation that you may feel while you're under water too long. Is that how you want to spend your last few hours?

    What a great way to increase the discomfort of the family and possibly the patient as well as make the death of a loved-one even more difficult and infused with negativity than it already may be.
    i dont have a problem with the med, the freq seems a little high....but the order was for euthanasia...."give untill resperations stop"....and it was a verbal order, unhu not this nurse.....doc can do that one him/her self....
  13. Visit  leslie :-D profile page
    17
    Quote from morte
    i dont have a problem with the med, the freq seems a little high....but the order was for euthanasia...."give untill resperations stop"....and it was a verbal order, unhu not this nurse.....doc can do that one him/her self....
    exactly.
    it is euthanasia.

    as for the dying process itself, it's truly non-invasive, painless and peaceful.
    how one (physically) dies is all going to depend on the pathophysiology presented.
    and, there are definitive ways to assess for pain/distress/anxiety.
    if a pt is demonstrating air hunger, we aggressively treat w/meds.
    furthermore, we aggressively treat and maintain regimens until we are 100% satisfied that pt is dying w/o pain.
    it's all about intent.
    when you administer morphine to abate suffering (aeb specific s/s), then it is ethically and legally acceptable.
    but when you start administering a drug to appease the family's anxieties, then intent is misplaced and therefore, inappropriate.
    we are there to support the pt's dying process first and foremost...
    and always.
    once we start giving outrageous dosages with frequencies that would kill an elephant, then there are definte legal and ethical boundaries to consider.

    with that said, yes, i know of many nurses that still administer unnecessary dosages per md orders...per family requests.

    i don't and won't.
    if i know my pts are comfortable, then i educate the families as to how distress presents itself, and empathize with their fears, anxieties.
    i explain the dying process, give permission to leave or whatever they need to do.
    but as a longtime hospice nurse, i have never, nor ever will administer meds to placate the family or anyone other than the pt.
    pts are my first priority, and i will care for them passionately yet legally and ethically.
    it's the only way i could sleep at noc.

    leslie
    jo1828, jlivermore, MrsMommaRN, and 14 others like this.
  14. Visit  Wise Woman RN profile page
    3
    Earle, I admire you so... not just for this post, but because of all of your posts. It makes me feel that somewhere, a nurse can be a nurse again, and care for patients.
    Your strength and common sense, as well as your kindness, are evident in everything you contribute to this board. I also agree with you that I would not dose a patient to make the family comfortable.
    ShayRN, Blee O'Myacin, and leslie :-D like this.
  15. Visit  Dolce profile page
    2
    Quote from earle58
    exactly.
    it is euthanasia.

    as for the dying process itself, it's truly non-invasive, painless and peaceful.
    how one (physically) dies is all going to depend on the pathophysiology presented.
    and, there are definitive ways to assess for pain/distress/anxiety.
    if a pt is demonstrating air hunger, we aggressively treat w/meds.
    furthermore, we aggressively treat and maintain regimens until we are 100% satisfied that pt is dying w/o pain.
    it's all about intent.
    when you administer morphine to abate suffering (aeb specific s/s), then it is ethically and legally acceptable.
    but when you start administering a drug to appease the family's anxieties, then intent is misplaced and therefore, inappropriate.
    we are there to support the pt's dying process first and foremost...
    and always.
    once we start giving outrageous dosages with frequencies that would kill an elephant, then there are definte legal and ethical boundaries to consider.

    with that said, yes, i know of many nurses that still administer unnecessary dosages per md orders...per family requests.

    i don't and won't.
    if i know my pts are comfortable, then i educate the families as to how distress presents itself, and empathize with their fears, anxieties.
    i explain the dying process, give permission to leave or whatever they need to do.
    but as a longtime hospice nurse, i have never, nor ever will administer meds to placate the family or anyone other than the pt.
    pts are my first priority, and i will care for them passionately yet legally and ethically.
    it's the only way i could sleep at noc.

    leslie
    Thanks for your post Leslie. I was hoping you would respond to this post. I'm all for comfort care and treating pain and anxiety during the death process but I would never given MS until "respirations cease." That is not the point of giving morphine. It is not my job to dictate when a patient dies for the convenience of the doc and family.
    Blee O'Myacin and leslie :-D like this.


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