tachypnea symptom.

May I add one thing? Perhaps the OP was seeing kussmaul's respirations. If the pt had a reason to be very acidotic, ie renal failure, resps become deep, fast and "machine-like".

When I've seen it, it seems to be pretty resistant to opiates ... we keep pushing it anyway but it takes a lot of morphine to make a difference.

Poor Oncall Lorraine! Ouch!
I would have given Roxanol, and possibly Ativan also. But please, hospice colleagues, let's remember Lorraine has six years experience, obviously cares, and unlike the rest of us, ACTUALLY KNEW THE PATIENT. Was there something happening in that home that we're not aware of?
There is nothing worse than calling into the office (or hearing the day after a 2 am crisis) .... "what do you mean you didn't...? " or "Don't you think you should have...?"
Of course none of us get it right all the time. Good for Lorraine for soliciting opinions.

Ok I'm confused by that statement vs the one in the original post.....

" i felt that using roxanol to slow him down did not seem appropriate, somehow."

Sometimes during the dying process the breathing can become labored and "machine-like". As in Kussmauls respirations. I've experienced it myself with a few patients. Sometimes you are able to assist your patient in a "good death". Then, there are a few that no matter how much Roxanol and Ativan you administer....it just doesn't seen to ease the breathing. I understand how horrible it can make you feel when you are unable to ease and make your patient comfortable. I unfortunately experienced this when my dad passed away last May. My dad responded to absolutely no painful stimuli.....he just kept breathing 30-40 x/min. This went on for almost 24 hours.He was a labored breathing machine. Believe me...I tried all the Roxanol and Ativan possible. Nothing eased the respirations. It was very difficult to watch as a nurse but also as a daughter. There are just some...and very few patients, in my experience, that have went through this.

All that being said, even if the pt seems to be having kussmaul's resps, you still need to medicate aggressively ... can you imagine how much your intercostal muscles must hurt after only a short time breathing that hard?

I tend to max out on both opioid and benzos in this situation ... I just don't expect a dramatic response in terms of resp rate ... I figure I'm treating the pain of having such a fast rate in the first place.

We actually know very little about physiological processes involved in the ending of a life ... our patients deserve a rest from aggressive testing, so we're going on theories and empirical experience more often than not. We can only guess at what an "unresponsive" patient is actually feeling while going through it. I can only imagine what it would be like for me to go through it and do the best I can.

Just wanted to say thanks for this thread. I am new to hospice--and this information was so helpful this week when my patient died. She was unresponsive--with deep, rapid respirations. My instinct was to medicate aggressively and you have confirmed for me that this was the right thing to do.