I have a hospice patient, admitted with ES Cardiac, and co-morbity of Gastroparesis. I am having a nigtmare of a time trying to get his ABD pain managed. Attempted to resort to using a Morphine PCA, but his wife backed out at the last minute, so now we are back to using PO meds. I have tried to educate myself on the disease, but there's just not a lot of information out there....especially related to pain management. So, I am turning to you....
Currently, he is receiving MS Contin ER 30mg PO Q8H, Morphine Sulfate IR 30mg PO Q4H PRN breakthrough pain (receiving ATC), and Roxanol 20mg/mL 1mL Q2H PRN breakthrough pain (receives almost Q2H ATC). Lorazepam 2mg PO Q4H PRN agitation, Reglan 5mg PO Q6H ATC, Phenergan 25mg PO Q6H PRN nausea (given ATC), Compazine 10mg Q6H ATC, and Zofran 4mg Q4H PRN nausea.
Now, I realize the morphine doses aren't very high. However, I just started working with this particular patient 2 weeks ago (another nurse was managing). Since I started working with him, the ER and IR doses have been increased from 15mg to 30mg. There's a long way to go with increasing the doses; however, there's been no significant change since increasing them over the past week. My patient still rates pain 10/10. The pain is not constant. He will be fine, then suddenly be in a pain crisis. He rarely eats ANYTHING. His blood sugars stay around 100-200, mainly because his caregiver gives Prednisone 5mg Qday. He has almost constant nausea, with intermittent dry heaving. Stools are white, and he is jaundiced, making me believe his liver is involved somehow. This is exactly why I wanted to convert to a PCA, because in my experience, any patient with liver issues/cancer, tend to do soooo much better when medication administered any route BUT oral. We use subcutaneous route for our PCA's (continuous infusion). Plus, he has a hard time keeping pills down with the n/v.
Please ask me any questions. I am begging for help! This man has absolutely no quality of life, and it's really bothering me. I know we have him for ES Cardiac, but our goal is symptom managment, regardless of the underlying cause.
