Morphine and Hospice Patients that are dying

[suzi0612]

Hello, I am a new nurse and I recently graduated with my RN and taking RN boards soon but working as a LPN at a long-term care facility. I got to take care of a patient that is dying and is hospice. We have a morphine order that reads like this in our mar: 10-20mg morphine sulfate sublingual every hour as needed for pain/dyspnea. I was doing some research online and I see a lot of orders every 4 hours not every hour. What are normal morphine orders in dying patients, is this dose to high? Any input would be greatly appreciated. I was just curious! Thank you.

[ellen 12]

That's interesting. I work in aged care facility- with 6 bed hospice.

Giving SL every hour would ensure pain wasn't adequately treated, nurses are just too busy.

When I start the pump - I know my patients are ensured of having their pain treated. the pump is charted with a PRN dose for breakthrough pain, and the dosage in the pump is increased until the dose is effective.

I live in New Zealand.

[tewdles, RN]

In the USA, I believe that if a patient living in a facility requires pain medication routinely more often than Q4 hrs we also employ some other way to insure comfort. At end of life an infusion would certainly be highly considered, at least in my experience. For patients in the home, we may well be able to adequately control their symptoms with SL meds, but the family generally has much more time to tend to the patients direct needs than a facility nurse does.

[Gemini62]

I am not a nurse but a caregiver for a for a loved one. This is probably not the place to post her struggle, I apologize, I need more info, but to give a short synopses; she has been on 10mg hydrocodone, 4 x daily for years, started 25mg/ml fentanyl patch a year ago currently up to 75mg/ml with hydrocodone now used for breakthrough. She is losing her struggle with small cell lung cancer, so hospice is now working with me to keep her comfortable and are wonderful. She has not eaten in two weeks, anything she tries to eat comes right back up, drinks water, which comes up most times, and is still complaining of stomach pain and nausea. I am applying ABHR and promethazine topical gel every 4 hrs, on a 2hr alternating schedule; giving a 25mg prochloperazine suppository every 6hr, hospice nurse discussed getting 50mg for every 12hr with .5ml haloperidol liquid when awake. My question is will the morphine not increase the nausea she is already experiencing?

[Call me Al]

Gemini, you sound like a wonderful caregiver. The best thing for you to do is call your hospice and discuss the unmanaged symptoms with them. I'm sorry your loved one is going through this.

[Gemini62]

Thank you Call. As I told a friend that asked what I got paid to do this: This is a prepaid job, she helped me so much with my life, it is the least I can do for her. I plan on calling as soon as Mother-in-Law=mil, is headed home. Been a step an fetch it all day as mil has had 3 strokes. At one point today if looks could have killed, daughter would be burying mom instead of the other way around. I need a few minutes "me" time before I call and she is asleep at the moment.

I found this thread today when I did a search on morphine and who better to ask than the people that deal with this every day. Dr's I've dealt with during her illness have talked down to me about her condition and I don't deal very well with people that feel they are better than I am but that is another rant best left some place else. I am an ex-Seabee and the "Can Do" attitude has given me the strength to carry out my task, I salute the rest of you that do this job day in an day out for total strangers.