MORPHINE and Dying Patients - page 15

by constantlylearning 122,848 Views | 221 Comments

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


  1. 0
    Remember morphine alleviates pain, but also anxiety, and air hunger during the end of life. As the others have said, vitals signs are not indicative of pain...especially in those who have had extreme or chronic pain.

    You should never force meds on someone, nor should the families wishes override the patient's. We are there to advocate for our patient's comforts, wishes and choices-whatever course that may take. Again, it is not about us or our beliefs. It is about our patients ONLY...AND THEIR NEED.

    Maisy
  2. 0
    My husband and I had a similar discussion a few months ago. My mother passed away from lung cancer and during her final 24 hours or so, they increased her morphine dose to keep her from having pain. My husband said that it was like they were "putting her to sleep" like a vet would put an animal to sleep. It was really hard for me to have to watch my mom die right before my eyes, but knowing that she wasn't in any pain was a great relief to myself and my brothers. I don't think my husband will ever change his opinion, no matter how hard I try to explain it (with information I have obtained from hospice nurses).
  3. 1
    Quote from MiaKea
    My husband and I had a similar discussion a few months ago. My mother passed away from lung cancer and during her final 24 hours or so, they increased her morphine dose to keep her from having pain. My husband said that it was like they were "putting her to sleep" like a vet would put an animal to sleep. It was really hard for me to have to watch my mom die right before my eyes, but knowing that she wasn't in any pain was a great relief to myself and my brothers. I don't think my husband will ever change his opinion, no matter how hard I try to explain it (with information I have obtained from hospice nurses).
    mia, i'm truly sorry about your mother.
    but i'm relieved that she died peacefully.

    there's a big difference in the analogy your husband brought up.
    a vet's intent is to put an animal to sleep.
    nsg's intent is soley to treat pain.
    we are not putting anyone to sleep.
    i don't understand why some neglect to see the difference.
    it's solely about one's intentions.

    i watched my mom die, too.
    and knowing what i did about mom's disease process, more than ever, i say, "thank God for morphine", and an even bigger thank you, to the nurses who put their pt's issues ahead of their own.

    leslie
    MiaKeaRN likes this.
  4. 3
    I have been a hospice continuous care nurse for 7+ years and I have no reservations about it what so ever. There is nothing worse than seeing an activly dying pt in pain and uncomfortable. I sometimes wonder if we give enough. Some docs are not comfortable (Usually non hospice docs) and won't order it titrated Examp. 0.25 mL - 2mL prn Q 2 hours. That can really tie a hospice cc nurse's hands and then were caught between the family wanted and pleading for me and the case mgr RN to do something when it's all in the docs hands or the family is scared of the morphine. It is also important to remember to get ms order for dyspnea/labored breathing. Does any one really believe that the pt is going to come out of this with drug problem!
    Farmer Jane, grace90, and MAISY, RN-ER like this.
  5. 0
    Quote from AUsomeBSN
    I am a quite new nurse with 6 months experience. I work on an ortho/neuro med surge floor. I definitely have an issue with giving morphine to a dying patient when I don't see any s/s of pain whatsoever... or if the patient says to me they don't want any morphine even though the family is pressuring me to give it every 2H. I am, however, not uncomfortable with giving it if I see that my patient needs it and they are showing s/s of pain (i.e. facial grimacing, movement, vitals, etc...).... My question is, what do you do when the family wants to dictate if the patient is in pain and they want the patient to have the morphine pushed every two hours around the clock, even when it's a PRN order????
    You should explain that the pt. will tell you if he/she is in pain, you are not medicating a family and shouldn't. They don't know if the pt. is in pain, you are trained to tell if a pt. is in pain the family is not. Families can get very anxious over the whole thing, but should not. You are the nurse,remember that. mso4 gtt.
    is used only if pt. is a DNR and there is nothing else that can be done:spin:.
  6. 0
    Quote from hospiceprn
    I have been a hospice continuous care nurse for 7+ years and I have no reservations about it what so ever. There is nothing worse than seeing an activly dying pt in pain and uncomfortable. I sometimes wonder if we give enough. Some docs are not comfortable (Usually non hospice docs) and won't order it titrated Examp. 0.25 mL - 2mL prn Q 2 hours. That can really tie a hospice cc nurse's hands and then were caught between the family wanted and pleading for me and the case mgr RN to do something when it's all in the docs hands or the family is scared of the morphine. It is also important to remember to get ms order for dyspnea/labored breathing. Does any one really believe that the pt is going to come out of this with drug problem!
    I agree with you, I work in a cancer center and I have seen some very large doses of ms-contin and oxycontin, but we only use a mso4 gtt. in DNR pts. who are actively
    dying and the dose usually starts at 1mg an hr. continuous and the doctor will give orders to titrate the gtt. .5mg to a certain dose. then we usually call if the pt. needs more.:spin:
  7. 3
    Quote from Tweety
    It's hard being the one to give a "death dose". I medicated a patient with 10 mg of MS and she died within minutes. I didn't feel bad because the day prior she was restless and expressing horrible pain. The next day I came in, and she was comatose and in the process of dying. He BP was horribly low but her respirations were rattly and tachypnic. Knowing her pain suddlenly wasn't cured overnight, I gave her the medicine.

    Did my giving her the Morphine kill her? Did the cancer kill her and I just sped it up?

    I'd like to think her last breaths were comfortable and her pain was relieved and I pray some nurse does the same for me when I can't speak for myself.
    I feel the same way Tweety when it will be myself. Well said.
    scooterRN52, grace90, and hospiceprn like this.
  8. 0
    Quote from HM2Viking
    As much as I dislike the ROY nursing model, I think you hit the nail on the head. Proper pain relief for the patient eases the families adaptation to the dying process.

    One other thing that I thought of as I read this thread. Nausea/vomiting is a sign of moderate pain. Appropriate pain relief may head off really unpleasant events for the patient.

    My great aunt died last summer from kidney failure. In the 2 years prior to her death she was put on hospice several times. She was given acetaminophen which relieved her pain and made her more comfortable. (She was nonverbal and would just cry.) She was taken off hospice and the nursing home staff would stop the acetaminophen. She would experience pain again. My mother was constantly working with the home to improve her pain regimen. This wasn't morphine but it does speak to how analgesics contribute to comfort care.

    My wife's grandmother died of liver failure about 10 years ago. The doctor refused to increase her pain medications to increase her comfort level with additional morphine because of some personal religious belief that pain should be experienced as part of the dying process. This was in a catholic hospital but I think that his beliefs were a distortion of religious teachings. I don't buy that any patient should be allowed to suffer.
    HM2viking,

    I think your right about the doctor's distortions, no doubt.
  9. 0
    I gave the last dose to my Mom before she died. Ratty resp. ,comatose, but obviously in the last moments of her life. Cried for months over that , but will never regret the fact that my mother died without pain and that her grandchildren,holding her hands in death ,did not see their grandmother suffer in her last moments.
  10. 7
    Let me just say this MORPHINE IS NOT KILLING THE PATIENT THE CANCER OR WHAT EVER TERMINAL DISEASE IS DOING THE KILLING. Morphine is making them comfortable. I don't understand why that is soooo hard for people to get.
    Farmer Jane, Libitina, scooterRN52, and 4 others like this.


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