Roxanol and the dying hospice pt in a LTC Facility

Nurses General Nursing

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Actively dying hospice pt in LTC facility. Roxanol order for 5mg Q1H PRN. Assesses patient respirations 11 resting quietly eyes closed. Pt didnt moan grimace etc during turning and repostioning Q2H. PRN Levasin given for increased secretioms and frequent mouthcare provided. Oncoming nurse upset because pt didn't get PRN Roxanol. Would anyone have done differently?

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Specializes in Cardiac (adult), CC, Peds, MH/Substance.

The oncoming nurse isn't really your concern. You used your judgement. If it will make you more comfortable, it's worth discussing with the hospice nurse though.

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This comes down to a difference in global views on pain management. I've seen hospice nurses that believe no matter what, PRN pain meds during the last few days should be given ATC, no mater what, while I've seen others who only give it per their judgement.

Personally, I fall in between those two in the case of hospice patients. I won't give it for absolutely no reason, but I will not wait to see active signs of pain either.

You didn't do anything wrong, you just have a different pain management philosophy than the oncoming nurse.

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I used to work in LTC. If the Roxanol is PRN and he has no signs of pain or distress, then I would have not given it too. Resps were under 12... while not critical, it would make me be extra cautious about administering another dose. You did the right thing.

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Specializes in IMC, school nursing.

I have witnessed nurses who believe ATC despite no S/S of pain is the right thing to do. Amazingly, these are the same nurses that believe that euthanasia is acceptable. I honestly believe they are being compassionate in their care, but my belief systems don't allow me to do that. You did what you were comfortable with, the patient was given excellent care and you caused no harm. Great job.

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Did you give any roxanol at all during your shift?

What about the preceding shifts, any given then and how often?

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I did give it once the nurse before me 2 times but the night nurse gave it every hour. I've only been a nurse 2 years and was questioning myself when I left work. Thank you everyone.

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