Morphine and Hospice Patients that are dying - page 3

by 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... Read More


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    Most the time we took it out of the E-Narc Kit so,...
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    The doctor charted morphine to be given as required. So the goal is to treat symptoms with a relatively small dose until the dose is effective. Sublingual is an unusual way to give morphine, if the patient has lost their swallow - we use a pump in a measured 24 hours dose s/c.
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    Quote from czyja
    Fascinating. How do you measure .125 ml? I suspect it cannot be done outside of a laboratory setting. Seems odd that your pharmacy signs off on an order like this.
    There are syringes that come in 0.5 mL and the marks make it easy to measure out such small doses.

    Often, when we have patients on OxyFast or the like, pharmacy measures out the doses for us and have ready made syringes in the AccuDose, so we don't have to worry about that.
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    Quote from ellen 12
    Sublingual is an unusual way to give morphine, if the patient has lost their swallow - we use a pump in a measured 24 hours dose s/c.
    We use the SL route 99% of the time. If pain is uncontrolled, we'll start an infusion pump.
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    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.
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    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.


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