patients eyes moving back and forth horizontally... dying?

  1. 1 Had a new admission today - pt was a full code, supposed to go to step down unit. But came to our med surg today after she was stabilized on 100% face mask (aspiration). She got up to the unit right at shift change. Pulse ox was 97-100% when she first got up there. THen went into respiratory distress when the day shift nurse and CNA were in the room - pulse ox went down to 66% at the lowest. rapid response was called and they gave her Lasix, suctioned multiple times (bloody?!), ABGs, etc. (BTW this patient is from a nursing home, + MRSA, contractures, G-tube, colostomy, completely aphasic, eyes are open but pt is nonresponsive at baseline, the works).

    They finally got a hold of the Dr who talked to the family (who hrs earlier wanted her to be intubated) and made her comfort care. (The critical care nurse who was talkign to MD on the phone mentioned the Dr wouldn't give a morphine drip order). Another dr who was on the unit came in and mentioned her eyes were moving back and forth horizontally and the day shift nurse asked a critical care nurse what he meant by that and the CC nurse said it means she's dying. Is this true? What makes this happen?
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  3. Visit  NurseyPoo7 profile page

    About NurseyPoo7

    NurseyPoo7 has '7' year(s) of experience and specializes in 'Acute Care'. From 'USA'; Joined Jul '08; Posts: 296; Likes: 214.

    13 Comments so far...

  4. Visit  hypocaffeinemia profile page
    2
    There are many different causes of nystagmus.
    Altra and NREMT-P/RN like this.
  5. Visit  NREMT-P/RN profile page
    0
    Without - Actually being there -

    I will suspect that maybe a "Doll's Eye's" reflex is present.

    It is a bit creepy the first time (heck, anytime) you see it. It is usually indicative of catastrophic brain stem issues.

    I think that you had a difficult situation.

    I may not always KNOW what is right - but I rarely have problems determining what is KIND. NOT euthanasia - so, hold it folks - but, compassionate care.

    Practice SAFE!


    Sounds like you did the BEST you could.
  6. Visit  Jo Dirt profile page
    3
    Quote from NREMT-P/RN
    Without - Actually being there -

    I will suspect that maybe a "Doll's Eye's" reflex is present.

    It is a bit creepy the first time (heck, anytime) you see it. It is usually indicative of catastrophic brain stem issues.

    I think that you had a difficult situation.

    I may not always KNOW what is right - but I rarely have problems determining what is KIND. NOT euthanasia - so, hold it folks - but, compassionate care.

    Practice SAFE!

    Sounds like you did the BEST you could.
    They call it "comfort measures" but it is really euthanasia. They start in with the morphine and keep giving a little more and a little more and a little more. I don't think this is wrong and I hope I'm treated so mercifully, I just wish we could call it what it really is.
  7. Visit  NREMT-P/RN profile page
    3
    Quote from GoLytely
    They call it "comfort measures" but it is really euthanasia. They start in with the morphine and keep giving a little more and a little more and a little more. I don't think this is wrong and I hope I'm treated so mercifully, I just wish we could call it what it really is.
    Somehow, I think that ANY possibility of JAIL or PRISON would keep us from using a correct or "kind" terminology.

    I agree with you however.

    Better to go out in the humane arms of "morpheus" in an kind and manner consistent with "compassionate care" than to leave this earth struggling in all types of agony.

    NO I am not "playing God" - just being a NURSE - one that values dignity and quality of life.

    IMHO -

    Practice KINDLY and SAFE!
    Jo Dirt, skittlebear, and HappyPediRN like this.
  8. Visit  Altra profile page
    0
  9. Visit  NREMT-P/RN profile page
    0
    Interesting and GREAT ethical discussion.

    I have done things to patients in the interest of "legal" issues that may land in me in H*%% - but, as I believe in a compassionate God - I'll pray for forgiveness and mercy.

    However, I suspect that MANY other "healthcare folks" will be in the same spot of "judgement".

    Practice SAFE!
  10. Visit  starbellyjm profile page
    0
    Nystagmus can also be caused by certain medications and medical conditions. I had an albino client in a long term facility and nystagmus was her baseline. Was it something acute in this patient?
  11. Visit  fins profile page
    3
    Quote from NREMT-P/RN
    Without - Actually being there -

    I will suspect that maybe a "Doll's Eye's" reflex is present.

    It is a bit creepy the first time (heck, anytime) you see it. It is usually indicative of catastrophic brain stem issues.

    I think that you had a difficult situation.

    I may not always KNOW what is right - but I rarely have problems determining what is KIND. NOT euthanasia - so, hold it folks - but, compassionate care.

    Practice SAFE!


    Sounds like you did the BEST you could.
    This IS usually an indication of brain stem damage, but it isn't the Doll's Eye reflex. The Doll's Eye reflex is a normal finding. If you hold a patient's eyes open, then turn the head, the eyes will stay pointed in their original direction briefly. (So if the eyes are pointed at the ceiling, and I turn their head, the eyes will stay pointed at the ceiling at first.) The absence of this reflex (meaning if I turn their head, the eyes come with it) is, to use the medical term, really, really bad.
    Pedi-Gree, skittlebear, and nrsang97 like this.
  12. Visit  Babs0512 profile page
    0
    Nystagmus can be caused by many things: Ocular Albinism which is a lack of pigment in the retna that albino's have. You can also have ocular albinism with normally pigmented skin/hair/irises.

    Brain injury, various kinds, can cause nystagmus.

    Medications, especially those used for anesthesia ie: Ketamine, can cause nystagmus.

    Nystagums can also be caused by something as simple as a severe otitus media, or laybrinthitis.

    My son has ocular albinism with congenital nystagums. He has normally pigmented skin/hair/irises, but he is legally blind.

    Blessings
  13. Visit  Babs0512 profile page
    3
    Quote from GoLytely
    They call it "comfort measures" but it is really euthanasia. They start in with the morphine and keep giving a little more and a little more and a little more. I don't think this is wrong and I hope I'm treated so mercifully, I just wish we could call it what it really is.
    Sorry, I have to strongly disagree with you. My mother was dying from various intercrainal hemorrages. I signed DNR paperwork which included a Morphine drip after I made her "comfort care". While my mother wasn't concious, no one was sure if she was having pain or not. I suspect brain herniation is painful, don't you? Anyhow, she was kept on Morpine, we had no way of knowing if it was helping. I judged by the only parameter I had, her vital signs. If her HR became elevated and her resp rate increased, we would up the morphine, and her HR and Resp rate would normalize. Was this "normalization" the result of the Morphine or the result she was more comfortable???? No one can say. We upped that drip for 3 days before she passed. By the time she passed away, she was tolerating quite easily 64mg Morphine/hour. We were told that in their Neuro ICU, having someone on a Morphine gtt above 100mg/hr wasn't unusual.

    Since you weren't there, you'll have to take my work for it, increasing Mom's morphine absolutely did NOT speed up her dying. It dragged on for 4 days.

    Comfort care is NOT euthanesia. It's the way we should care for our dying so they can be as comfortable and dignified as they can be. If we can't change the outcome, we should make the process of dying as minimally stressful as possible for the patient AND their family.

    Blessings
    leslie :-D, Hoozdo, and nrsang97 like this.
  14. Visit  tencat profile page
    4
    Quote from GoLytely
    They call it "comfort measures" but it is really euthanasia. They start in with the morphine and keep giving a little more and a little more and a little more. I don't think this is wrong and I hope I'm treated so mercifully, I just wish we could call it what it really is.
    Wow, it would be nice if some folks would get their facts in order before throwing out such a blatant accusation that comfort care equals euthanasia. We do not keep giving 'a little more' morphine just for the heck of it to kill patients. Some patients do well with a little morphine (4 mg/hour) some do well with ungodly amounts of narcotics. I had a patient who had 400 mcg of Fentanyl and hour and was STILL in pain. I was not trying to 'kill' the patient. I was trying to make the patient comfortable. Patient was breathing fine and was alert. He had cancer. In no way did I (or the physician) cause his death. The cancer did that. Euthanasia implies intent to kill. Comfort care is not intended to kill, but keep patient free of pain and discomfort.
    Pedi-Gree, nrsang97, leslie :-D, and 1 other like this.
  15. Visit  leslie :-D profile page
    0
    Quote from tencat
    Euthanasia implies intent to kill. Comfort care is not intended to kill, but keep patient free of pain and discomfort.
    thank you, tencat!!
    and yes, let's call it for what it really is!!

    sheesh.

    leslie


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