Pain Medicine for a dying patient ... - page 2
by Tweety 24,927 Views | 66 Comments
with unstable vital signs. The patient is very near death and is a DNR. A scenero such as a patient that is actively dying, vitals signs are poor, bp low, heart rate low, respirs low. The patient is moaning. The family... Read More
- 0Dec 21, '03 by Hellllllo NurseI worked aa an inpt acute hospice nurse for four years.
We routinely had pts w/ resp rate of 4-6 getting 20-100mg MS04 per hr who lived for days and weeks that way. I do not think I have ever seen MS hasten death, although it would have been a blessing in some cases.
- 0Dec 21, '03 by TiffyRNA good oncologist once counseled my good friend (also an RN) about this very thing, giving IV morphine to a dying patient who was in pain. She was very torn about doing it thinking she would "cause" this patient's death. He told he "the morphine isn't what's killing her, Cancer is killing her. You are relieving her pain". She gave the morphine with tears in her eyes and witnessed this woman as her pain was relieved and then she passed away peacefully within the hour. My friend came away sad that his poor patient had to suffer at all but comforted that she was able to help the patient. By sharing this experience with me we were both able to learn something.
- 0Dec 21, '03 by sbic56Originally posted by cyberkat
The same thing was taught in my bio-med ethics class. There is always a *final dose.* The intent of that dose defines whether it's pain relief, euthanasia, or murder.
Tweety, when my mom was dying, she presented just as you describe your patient. I asked the nurse to give her some more MS and she wouldn't because her resps were something like 8. My sister and I were incensed, of course. I told her to draw it up and I'd give the damn thing myself. We ended up going over her head and the MS was given.
- 0Dec 21, '03 by VickyRN Senior ModeratorThe patient HAS to be terminal. The patient has to be in the last stages of dying. The patient HAS to be a DNR. The family HAS to be in agreement. The doctor HAS to have written the PRN dosage just as you are giving it, and it has to be within accepted pharmaceutical dosages. Anything done outside of those boundaries can cause a nurse to lose her license, endure a civil suit, or go to jail. (As Mattsmom81 has cautioned us). It is only common sense that giving that last dose of morphine does not "cause" death in a patient who is in the thoes of dying anyway. We KNOW that, but all too often the uneducated, hysterical, suspicious family does not.
That said, I certainly don't want to sound unsympathetic to the dying patient in pain. Every patient should be as pain-free as possible, and have a peaceful passage. This is a basic human right.
- 0Dec 21, '03 by NursePaulaOf course the Dr has to have written the order and it needs to be given exactly within those parameters, but why does the pt HAVE to be a DNR to have their pain managed? Also, I think as far as the family is concerned teaching them about pain management is a given.... I took from the original post strictly that a concern was raised about if a dose of ordered pain med would kill the pt. Back to the family issue, yes the family has to agree to a certain extent, but also does the pt have an advance directive? or does one person have power of attorney? And being a true PATIENT advocate means trying to bring all these factors together so that the pain can be managed.
Am I way off base here???? I didn't think so but...I am always open to learning.
- 1Dec 21, '03 by VickyRN Senior ModeratorIn reply to the above post: "Full code" AND terminal "Aunt Mae" has just been admitted to your unit. She is on a ventilator and 4 different pressors to keep her BP in a barely liveable range. Her nephew, who has POA, insists that EVERYTHING be done for "Aunt Mae" because "she deserves it." Yep, right. Is "Aunt Mae" going to have a peaceful death???? I think not. Her last fleeting memories as she departs this life will be someone beating on her chest, breaking her brittle ribs, multiple shocks with defibrillator paddles, needle sticks, multiple medications and fluids being forced into her fragile veins. No, not a peaceful passage at all. A travesty. But a scene too often witnessed in the ICU and a very, very difficult position for the nurse to be in.
- 0Dec 21, '03 by AgnusThe disease is killing the patient. Reguardless they are entitled to pain relief.
Morphine is not the killer we give it credit for, if used correctly. If the patient is termainal and in pain it is likeley this is only one of many doses given over the course of the illness. The patient has developed a tollerence and even possible a dependence meaning he requires > doses. This being the case the patient is not narcotic naive. He can handle the does without it depressing respers to the point of fatality.
I have used a lot of ms with suffering patients and have yet to give a dose that has proven fatal. Did you know there is no dose ceiling on ms? Did you know it is the weakest of the narcotics?
Intent is everything.
Imagine if pain were not relieved and he died in terrible pain. Is that a better way to go?
I think enough nurses do not understand how ms works. Really undrstand, and undrstand about dependence, and tollerance.