I have started orienting in my hospice unit and I have to tell you, I'm loving my new job so far.
I love what I can do for a patient and for a family during the dying process and it seems I have a certain insight into this, don't ask me how, it just came with the transition. I take it as a sign of making the right move. Plus, I listen well to those experienced nurses around me and soak up all the info possible.
My question is regarding SL Roxanol. I was warned by my preceptor on the subject of teaching how morphine decreases respirations. For those of you who have dealt with this, what are some suggestions you can give me to steer clear of the idea of the morphine "killing" their loved one? I understand this is an education area and I just need to know the best way to approach/explain it. Are there certain phrases you have used that have been successful? Easing respirations, helping them relax, etc?
Thanks again for your weath of knowledge,
Feb 22, '11
Several points I discuss:
Most side effects people get used to- but not constipation.
SL morphine is processed differently than IV morphine, so it has less tendency to cause confusion, hallucinations, somnolence
Morphine helps dilate the blood vessels of the heart which can help improve cardiac situations (remember MONA?)
Morphine has the effect of causing the brain to think a person is getting enough oxygen, thus treating dyspnea and slowing respirations-close monitoring will make sure a pt gets enough for comfort without overdosing. Also, pain and dyspnea are natural opioid antagonists
Also, a common phenomena in actively dying pt's is that symptoms that are unmanaged will cause stimulation of the sympathetic nervous system (fight or flight). The main effect of this is more alertness than would be expected (for example, someone may be mottled with terminal congestion but wide awake). Treating these symptoms will allow pt's parasympathetic nervous system to take over, and patients will relax and sometimes you will see major changes in the next few hours.
The other lesson that was very hard to learn at the beginning is that not every patient will die comfortably- sometimes they or their families will never be willing to allow the 'M' word to be given.
Last edit by ErinS on Feb 22, '11