I am an RN in LTC and recently had a very dear resident die. She was on hospice at the end. I have had some very "hard'" deaths, struggling, clenching fists, severe terminal secretions, flailing. This lady did not exhibit any of this, in fact, was quite peaceful and ready for her death. Morphine, atropine gtts, lorazepam intensol were ordered. My questions, one: I was told to give morphine for secretions. My experience with pharmacology suggests no correlation with an opioid stopping secretions. Also, I was told that morphine would be out of her system within 4-6 hrs after administration. This lady had renal failure, thus I would think clearance would take longer? The reason for my post really is this, if a resident is clearly not exhibiting pain or discomfort, why use morphine and "snow" them out of precious end moments with her family? Please understand that I have absolutely no problem giving medications for pain/discomfort control. I have used them and will in the future to make sure my residents are comfortable at the end.
Jan 30, '13
by BostonFNP, NP
Quote from cardiacrocks
Typically, we apply a scopolamine patch to dry up secretions. I've never heard that morphine helped to decrease secretions. It does help with breathing at low doses that is. I had a patient on 1 mg every 30 minutes at end of life. I'm unsure of why atropine was ordered for this patient though, why would you want to increase HR at the end of life? Sometimes it can't be helped, some patients just tug at our heart strings, and can be bothersome for a lot of nurses and other healthcare professionals, there are outlets for you. Please refer to hospice or see if there are any counselors at your facility that can help you through this. So sorry for your loss.
Atropine is a fairly powerful antiach agent that we use for secretions at EoL if they aren't responding to scopolamine (same pharma class, belladonna alks) or glycopyrrolate that can be given by ophthalmic drops to the back if the throat. They have no noticeable systemic effect by that route.
Morphine is a wonderful drug for terminal care that reduces oxygen starvation and keeps patients comfortable. It does not help the terminal secretions.
Last edit by BostonFNP on Jan 30, '13