Morphine & air hunger

  1. 1 Just looking for validation....

    Pt with severe COPD scheduled for surgery to repair a fracture was on the floor. Sats all over the place; mostly 90's with venti but pt wouldn't leave it on & drop to 50-70's. Back on nasal cannula, pt would leave it on & stay mostly in the 80's. Big mouth breather. Monitored by ICU with tele & continuous pulse ox.

    When I checked on the pt after a call from ICU re sats dropping again, pt looked like a fish out of water, unable to match slower breaths with me, sats staying in low 80's, accessory muscle use, RR 22-26....

    I suggested to the pt's nurse maybe give a little morphine (I assumed it may have been ordered for pain control d/t fracture) & felt like I was smacked in the face when his nurse with 20+years experience stated "What?! You want to give granny who can't breathe respiratory depression?"

    SMH...please tell me I'm right.
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  2. 20 Comments

  3. by   klone
    #1 12
    You are right (says my hospice nurse husband who deals with this all the time - I just read your post to him and he completely agrees with you). He said 5-10mg is not going to cause respiratory depression.
  4. by   RainMom
    #2 3
    Thank you! I wish I had more gumption to argue with her, but it wasn't my pt & frankly I was just dumbfounded at her reaction. Turns out the pt didn't have a morphine order anyway. Well, we shall see when I go back tonight if the pt even makes it back to the floor after surgery (in which case, hopefully the standard morphine pca is set up).
  5. by   RNNPICU
    #3 3
    Definitely would want to provide pain relief. You just can't let a pt sit in pain because a potential side effect is resp depression. All relief type medications, versed, ativan, morphine,etc have some resp component. I vote for pain relief!. It doesn't sound like you were wanting a dose to knock her out.
  6. by   loriangel14
    #4 6
    You are right IMO. We use morphine for respiratory distress all the time.
  7. by   Here.I.Stand
    #5 3
    Well I thought it was a great idea.
  8. by   klone
    #6 6
    Quote from RNNPICU
    Definitely would want to provide pain relief.
    It sounds like the OP was wanting to give it not for pain relief, but to relieve the patient's dyspnea.
  9. by   GrannyRRT
    #7 7
    Was the patient home O2 dependent and what liter flow?

    Where was the fracture? Always assess for other possibilities like an embolism or pneumo or glucose issues.

    Pain control is definitely a must and usually 5 - 10 MG of morphine is not an issue.

    When a COPD patient can not match slower breaths they have air trapped significantly. In other words their lungs are full of air which can not escape. They can only take short breaths which are ineffective in either ventilation of oxygenation. Coaching a COPD patient can be difficult and if done incorrectly, they can quickly decompensate to intubation. The patient must purse lip breathe effectively enough to splint the airways to relieve the trapped air. The morphine or something to reduce the anxiety enough for them to be able to do some respiratory maneuvers will help. A bronchodilator would be of use only if the patient can still actively participate in pursed lip breathing or if the med is given via a PEP device. Passively hanging a neb usually does very little.

    I also would recommend an Oxymask which is very light weight and open when oral care and suctioning can be done without removing it. It can be used for 1-15 liters eliminating the need to change devices.
  10. by   blondy2061h
    #8 3
    I think of morphine as good for air hunger in end of life patients, or in patients who are in the process of having the reason that they're air hungry addressed (ie, waiting for the bipap to reverse their acidosis). In this case, I think this patient needed more interventions to address the hypoxia, especially if surgery was planned. She probably needed to be moved to ICU and placed on bipap or a vent.
  11. by   firstinfamily
    #9 1
    The morphine would also act as a vaso-dilator, which would help increase blood supply to the lungs, and most likely help the patient. It would not really be considered a resp depresant unless they had been over-dosed with the morphine. We have given it for pts in respiratory distress because it relaxes the airways and usually that helps to eliminate the "air-hunger" experienced by the COPD pt. You were right in your judgement. The other 20 year nurse was just focused in another direction. YOu would have had to prove to him/her that you were right. Will the pharmacy supply medication actions and side-effects if requested???
  12. by   Tenebrae
    #10 2
    Definately right. We use morphine elixer (1mg/1ml) often with patients with severe SOB. Standard dose would be 2.5-5mls. Can be very effective used in the low doses
  13. by   AnnieOaklyRN
    #11 4
    That sounds like a patient who may need BIPAP or CPAP, if not intubation. What you are describing is someone who is no longer compensating for respiratory failure and Morphine is not going to help that at all!!

    If you give a patient in respiratory failure morphine and it does decrease their respiratory effort the results are not good, increased confusion because you have stopped them from what little compensation they had left. She is breathing fast in attempt to blow off CO2, increase her oxygen level, and correct respiratory acidosis from the hypoxia, if you interrupt that the patient is going to end up intubated and intubated COPD patients often times have great difficulty getting off the vent. If she was not complaining of pain or had no other indication that she was in pain and required pain medication, I would say no to the Morphine. Airway Breathing Circulation... always remember that!

    I would have checked that patient's blood gasses as well!

    A small dose of Morphine may not have effected her respiratory effort, but a patient like this is fragile, and if she was truly that hypoxic Morphine coupled with that and the fact the she was probably hypercarbic may have not ended well. I would have placed her on BIPAP, allowed her to recover if she was able to and then maybe tried some Morphine for pain if she needed it.

    What made you want to give this patient pain medication, was it her breathing or did she complain of pain? Did they rule out a PE?

    HPRN
  14. by   klone
    Quote from HappyParamedicRN
    What made you want to give this patient pain medication, was it her breathing or did she complain of pain? Did they rule out a PE?

    HPRN
    She was not using it as pain medication. She was using it to decrease oxygen metabolism, which then reduces oxygen demand in the patient, improving dyspnea.

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