Managing symptoms for a “good death”

We use atropine gtts for emergencies and keep those in a comfort box. But Scop patches work even better. We use the Atropine gtts (typically opthalmic gtts) under the tounge... 2 gtts every 4 hours as needed. We get the scop patches as soon as we can... 1-3 patches every 72 hours.

I'd like to have nurses talk about atropine, I've given more then ordered at the last hours.( It does help) WHAT ARE YOUR FEELINGS ABOUT THIS?

let's face it:
the dosages a/o, are inadequate.
you do what you need to do, to get symptoms under control.

leslie

I agree that the atropine dosage is inadequate when a patient is having an acute crisis with pulmonary congestion. In those instances I consider injectable scop to get a quick handle on it and then try to maintain with Atropine or levsin or the TD Scop. There certainly is benefit in the CHF patient (and many others) transitioning toward death in a slightly dehydrated state, the natural process usually takes care of this but there are some poor folks who come to us dying and wet. If you can plan for that transition it helps everybody involved. Remember to stress good mouth care to the caregivers when using these meds. Dry mucous membranes are a miserable side effect.
As clinicians we have to be cautious about these meds outside of the terminal phase. I did a PRN visit one night for a youngish woman with lung Ca using TD Scop for routine symptom management, she got a bit dry and developed mucous plugs with some significant atelectasis. She didn't want to go to the ER so I stayed with her and accomplished quite a bit of pulmonary toilet and got her comfortable again. (thank the LORD for my NICU/PICU days)

About the "good death" part. As a hospice nurse I define it differently than the patient or the family might. Not because my goals are different from theirs but because I have goals in addition to theirs. So for me, a "good death" is what ever the family and patient say it is plus all of the comfort and peace I can provide them in my role as case nurse.

HELLO! Yes Atropine dosage at this point in time are too low.I've given more in the last hours of death and it does help,ALOT!!!!! Our Medical Director knows we do it,but there is no written order. Cancer.org give .4ml sq ever 15 min. How can "WE" get this info out and help more pt.s have a more peaceful death?? I hope y'all will talk this out with me. Thanks