New to all this

Mazzi · Dec 11, 2003

I have two pt. right now that have ascites and both are on Ativan 0.5-1mg prn. Also one is taking Oxycontin 10mg q12 hr and the other is on a Duragesic 25 mcg patch q72 hr. This combination has helped a lot. Hope this hleps. One did have the ascites drained and the other did not and I see not difference in the end stages.

anita4 · Dec 12, 2003

Thanks for your response. How long can they carry on like this? How do you know when the end is near? Could she be up and down one day and passed the next? Or will she be bedridden first?

She is a psych patient and doesn't understand that she should just stay put. She is like a bulldozer. She goes to Bingo every night still. The other night she fell on the way home, so weak. Has maybe one meal supplement shake a day at the most. We can't keep her in the house, unless we tie her up!! Which of course we can't.

saribeth · Dec 12, 2003

Oh it is so miserable when our pts get ascites...one of our Docs will not in any way shape or form drain the fluid...he states it comes right back and the procedure is a big deal for most of the pts...however, spironolactone 200mg qd with lasix 40mg qd...takes approx 5days for the pt to get some kind of relief...good luck...wow it is one thing to be loosing your body and that poor pt has psych prob too, and by the way, let her play bingo till her hearts content as long as she is not in any danger of falling... although it sounds as if that is already an issue! :rolleyes:

Mazzi · Dec 13, 2003

A pt with ascites, if up and about can go for quite a long time. It is when the pt. becomes bedbound that you will see a change. Death is not a science. Some pt's can last, some go quick. You have to look at the big picture. When all s/s come together at the same time----that is when you can start to determine if the pt has days or hours left. s/s most likely are: respiratory distress, lethargic, some times mottling at knees and feet, decrease appitite or taking just liquids, weakness (which leads to difficulty swollowing, which leads to aspiraton) and big change in vital signs. (decrease in B/P and increase in HR) Hope this helps.

anita4 · Dec 14, 2003

Well right now, she has a meal supplement shake about 1 every 2 days. She already has difficulty breathing as she is a heavy smoker. After she has a smoke, the strangest wheezing will come out. No energy to cough even like she used to. Her right side has become more swollen, leg etc... Her ascites is tremendous. She is taking 2 x 15 mg. morphine time realeased tabs a day and 2 breakthrough pain at 5 mg. This is all up to the staffs discretion, as she doesn't peep about the pain, you can just see her discomfort (remember she is a psych pt. denies she even is sick). When she is awake she is soooo restless. Despite the pain she is up and down every 3 mins. She prefers to sit on a hard chair. She doesn't sleep at night, from the night shift interpretation is that she is "afraid" to sleep. I am so petrified that she will just drop dead while she is walking. In anyones experience with this type of cancer, do they die in their sleep or is there a huge crises, then they die? Or are they bedridden before they die?

saribeth · Dec 14, 2003

Oh how I wish our pts would just "die in their sleep" but alas, it usually is not the case. However, most pts usually become bedbound...semi comatose...then comatose and then they die...I have seen pts get up, talk, eat a full breakfast and then they just slip away...dying is just like living...it can be very hard and also most pts die as they live...in other words if they are a "kicking and screaming" kind of person then they will go out kicking and screaming (not literally of course!)although I have seen that one too! Don't be afraid...she is lucky to have you caring so much about her...hang in... maybe for her restlessness she would benefit from some Ativan...0.5 - 1 mg q 6 but then again she may be taking so much for her psych disorder...take good care:o

icuabbie · Dec 15, 2003

If there is any way to get Hospice involved they will be a tremendous help with the palliative care and contacting the Dr's. I worked in hospice for a while and we saw pt's in nursing homes and assisted living. I don't know if this patient would qualify for hospice benefits but it's worth looking in to. Unfortunately most Dr.s are not trained in palliative care and they don't always know what is best for the patient. Does she have an oncologist following her? They are usually intune with the palliative meds. Ativan is a great choice for agitation and restlessness. Many people get very restless when they are in the dying process. There comes a time when the nurses will need to advocate for just keeping her comfortable. Sometimes it takes a lot of drugs and if you havn't dealt with this you might feel like your over doing it. Contact Hospice. Most hospices will even make time to come to your facility and give an inservice to the staff. Good luck. She is fortunate to have someone who cares.

Mazzi · Dec 15, 2003

Why didn't I think of that-icuabbie... Yes, Yes, contacting your local hospice would be a great assess. Does this patient have family that you could explain hospice to, then you could contact the MD or they can. Your do need a doctors order to have hospice. Here in Indiana our hospice has to have a contract with the ECF, Assisted living, ect. If yours don't have a contract then an inservice would be wonderful. Call you local hospice.

eagleriver · Dec 18, 2003

It is hard to watch someone suffer, especially if there's nothing that can be done to make it better or to help the person understand and/or accept what is happening.

I feel that it is an honor to be with someone during their last hours and at the moment of transition, sometimes holding hands, stroking, and even holding them in my arms when it's appropriate.

Effective nurses Love ... through all of our functions, that is the common feature. We don't "create" Love. Instead, it flows from and through us.

Like a river that widens and deepens until it accomodates all the water that flows in it, our capacity to Love increases as we express it. Essentially, we channel Love from it's inexhaustible Source.

Knowing this, I am free to be totally committed to the dying patient, with no fear of becoming too attached or burned out.

Never doubt your strength. It is there when you need it.

eagleriver · Dec 18, 2003

by Sally Karioth PhD, RN

I've learned that nursing is the hardest and easiest thing I've ever done.

I've learned to take my job seriously but myself lightly.

I've learned that everyday I've held a hand but forgotten to chart vital signs I still may have come out ahead.

I've learned that nursing is extraordinary because we do ordinary things so magnificently.

I've learned that if 1 don't get emotionally involved with my patients it's time for me to change professions

I've learned that when you're 92 you shouldn't have to beg for the salt shaker even if you have CHF.

I've learned that a patient doesn't get Cancer, a family does.

I've learned that a good physician is one who will say, "I have no idea what's going on with this patient. come help me figure it out."

I've learned to help people see the 'gift of cancer.'

I've learned that if my child tells me she has a bake sale 'tomorrow' at 8 a.m. - to be thankful that it's a bake sale and not a teenage pregnancy meeting.

I've learned that whatever you need in a hurry will be in someone else's room.

I've learned that when the narcotic count is off, it's usually I who forgot to sign something out.

I've learned that healing the spirit is as important as healing the body.

I've learned that if I don't take care of myself I can't take care of anyone else.

I've learned that hospital food must be a punishment for our sins in a previous life.

I've learned that a body believes every word you tell it.

I've learned that the nurse 1'd like to have take care of the person I love most should be me or you.

I've learned that time flies whether I'm having fun or not.

I've learned that reality is what is, not what I would like it to be.

I've learned that if I can't cure, I can still care.

I've learned that patient-centered care doesn't mean amenities it means empowerment.

I've learned that one of the gentlest things I can do is attend all my patient's funerals.

I've learned that If I'm there before it's over that I'm still on time.

I've learned to separate between a minor event and a major episode.

I've learned that it's usually better to beg forgiveness than to ask permission, especially if I'm taking a St. Bernard to see a child in ICU.

I've learned that good nurses aren't measured as much by punctuality as by compassion.

I've learned that the spirit of the law may be more important than the letter of the law.

I've learned that every day 1 can make a difference in someone's life and that I choose to make it a positive difference.

I've learned that if I don't celebrate the exquisiteness of each day that I've lost something I'll never get back.

I've learned that what helps most when diagnosing patients is never walk behind or ahead of them. but rather walk with them and listen very carefully.

I've learned that the more unloving a patient acts the more they need to be loved.

I've learned that knowing when to stop treatment with a morbidly ill patient may be more important than knowing when to continue.

I've learned that some things have to be believed to be seen.

I've learned that addiction to pain medication is the least of our problems when a patient is in pain.

I've learned that professionals give advice but healers share wisdom.

I've learned that meditation, group work, nutritional savvy and massage are as integral to a cancer patient's care as radiation, surgery and chemotherapy.

I've learned that wearing red polka dot underwear under my uniform may not be the best choice.

I've learned that grief knows no rules.

I've learned that there is no room for bullies or whiners in nursing,

I've learned that you don't have to meet all the objectives to learn a whole bunch.

I've learned that nurses without a sense of humor should try to find a job as a shepherd.

I've learned that having to work two weekends in a row is a minor event when my breast biopsy comes back benign.

I've learned that I can work with almost any body fluid but mucus.

I've learned that student nurses will do something every day that I didn't think was possible.

I've learned that no one promises us tomorrow.

I've learned that medical students get anxious when I assign them nursing care or try to see if their chakras are open.

I've learned that if a confused patient accuses me of "poo-pooing" in his bed I should apologize and promise never to do it again.

I've learned that no one says on their death bed, "I wish I'd spent more time at the office".

I've learned that if a child is old enough to love, he is old enough to grieve.

I've learned that a lot of patients get well in spite of us but even more get well because of us.

5150dx · Dec 18, 2003

Originally posted by eagleriver
It is hard to watch someone suffer, especially if there's nothing that can be done to make it better or to help the person understand and/or accept what is happening.

I feel that it is an honor to be with someone during their last hours and at the moment of transition, sometimes holding hands, stroking, and even holding them in my arms when it's appropriate.

Effective nurses Love ... through all of our functions, that is the common feature. We don't "create" Love. Instead, it flows from and through us.

Like a river that widens and deepens until it accomodates all the water that flows in it, our capacity to Love increases as we express it. Essentially, we channel Love from it's inexhaustible Source.

Knowing this, I am free to be totally committed to the dying patient, with no fear of becoming too attached or burned out.

Never doubt your strength. It is there when you need it.

Eagleriver, I just wanted to say thanks for your post - I just shared my friend's last days and I came away feeling like that - a total positive... that is once I got hospice involved who helped make the doc face reality.

.... I just finished nursing school and look forward to working in hospice as soon as they feel I have enough med-surg experience. I used to work on an ambulance and so am not totally green... Thanks again!

Kristin