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| Advertisement Sponsored Links | | | | No. 11 | 
Mar 28, 2009, 03:41 PM
 Re: tachypnea symptom.
Agree with the others although morphine is usually our first chice. Dyspnea, tachypnea, even mild is distressing to any patient, and should be considered a priority. We utilize roxanol 0.25 to 0.5ml every 15 minutes until symptoms resolve then calculate how much it took to get the patient comfortable and utilize a range PRN Q hour thereafter (ie, 4 X .5 doses= 40 mg ) would be 20-40 mg hourly as needed to control dyspnea. We try to get a "may repeat" for the 15 minute order as well.
We make the mistake of telling our families that hospice will make their loved ones death a peaceful experience---sometimes that is not true. We should, instead, tell them that we will do everything we can to make the experience as comfortable as we can possibly make it. I have been in the field, and on call for hundreds of deaths, and there are those VERY FEW that, despite everything you have available in your arsenal, aren't as comfortable as you would have wanted them to be. We are only human--what allows us to sleep well at night is the clear conscience of knowing that we did everything within our human powers to make them as comfortable as we could have possibly made them, to do less, is to have failed them and ourselves as hospcie nurses.
 | | No. 12 |
Mar 28, 2009, 06:30 PM
Re: tachypnea symptom.
Morphine is the answer. But you tried to express that there may have been some other factors which were not evidence based which precluded your feeling morphine was what your pt needed. That happens to EVERYONE once in a while. But for this circumstance Roxanol with re-assessment was appropriate. When the rate decreased with, say 10-20mg SL, you may have chosen to direct the family to use q 2 hours (or whatever worked).
Another stratagy I have is to think, "if this was me what would I need?"
Live and Learn kuddos for caring and asking. Your next pt will be happy.
| | No. 13 |
Apr 02, 2009, 10:38 PM
Re: tachypnea symptom.
I don't want to criticize but I agree with all of the above. In my mind a respiratory rate that fast = air hunger... I wouldn't want to die feeling like I was starving for air.....next time give the meds...liberally and often. When a patient is actively dying I don't really worry about giving too many meds, my only focus is to keep them comfortable and anxiety free which means roxinol or oxyfast and ativan intensol as often as they need it.
Don't beat yourself up over this one though, use it to learn for the next one.
| | No. 14 |
Apr 05, 2009, 12:52 AM
Re: tachypnea symptom.
I am in med/surg, not hospice, but I do have an interest in hospice down the road. I'd like to add that I occasionally have alert and oriented med/surg patients with respirations in the 30's who deny pain. They just have shallow and rapid respirations. I get my fair share of COPD patients...and...with me being a relatively new nurse, whenever I assess anything that appears to me to be out of the norm on a pt, I always have a more experienced nurse come in to check the pt for my peace of mind.
I had a pt a few months a go who was lethargic with respirations in the 40's. I called the pulmonologist because I was sure she needed to be transferred to ICU. He ordered stat ABGs and a CT to rule out a PE. Long story short, she never was transferred to ICU and went home looking like a completely different woman the following week.
I personally feel that you were much too critical of the OP. Tachypnea is not always an indication of discomfort.
| | No. 15 |
Apr 05, 2009, 02:02 AM
Re: tachypnea symptom.
No tachypnea isn't always an indicator of pain but in a dying person who is otherwise unresponsive it's either pain or anxiety, either way you don't want to leave someone in that state from the hospice perspective. We want them comfortable, it doesn't really matter why they are tachypneic when they are in the dying process we just don't want them to stay that way, it's much kinder to give them something to ease their breathing.
| | No. 17 |
Apr 05, 2009, 11:00 AM
Re: tachypnea symptom. Originally Posted by Delirious  I am in med/surg, not hospice, but I do have an interest in hospice down the road. I'd like to add that I occasionally have alert and oriented med/surg patients with respirations in the 30's who deny pain. They just have shallow and rapid respirations. I get my fair share of COPD patients...and...with me being a relatively new nurse, whenever I assess anything that appears to me to be out of the norm on a pt, I always have a more experienced nurse come in to check the pt for my peace of mind.
w/med-surg, there can be many variable processes occurring.
even fever will increase rr.
it may not be "pain" as we visualize it, but it is still a stressor and needs addressing.
I had a pt a few months a go who was lethargic with respirations in the 40's. I called the pulmonologist because I was sure she needed to be transferred to ICU. He ordered stat ABGs and a CT to rule out a PE. Long story short, she never was transferred to ICU and went home looking like a completely different woman the following week.
I personally feel that you were much too critical of the OP. Tachypnea is not always an indication of discomfort. unless tachypnea is someone's baseline, it IS uncomfortable.
you were correct in calling the pulm doc.
and pt was managed on the med/surg floor.
but she was still 'managed' with whatever meds/txs she got.
as for this hospice pt, als destroys your body piece by piece, function by function.
furthermore it is the als pt's worst fear, that when their diaphragm/lungs fail them, they will suffocate to death.
a rr in the 50's is a CLEAR indicator of resp insufficiency.
given that we are trained to treat the whole pt (body, mind, spirit), AND the op being a hosp nurse x 6 yrs, i just cannot understand how/why this happened.
she truly failed that pt and there's no getting around it.
nor will i try to sugarcoat it.
as another poster stated, hospice is very different than any other specialty.
and it commands a whole lot more consideration in how we approach and treat the pt.
please learn much more about hospice before you decide to pursue it.
best of everything.
leslie |
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