Pain Medicine for a dying patient ... - page 3
by Tweety | 25,792 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 NursePaulaThank you Agnus!! I have taken many pain management classes and am still amazed at what nurses think about narcs. I had a pt come into the hospital just a month ago...long story short his diagnosis was intractable pain and he was taking approx 400 mg of MS in 24 hrs. at home. He comes in and the PCA ordered by MD was 300 mg in 24 hrs if he hit the button at every possible allowed time...needless to say I was on the phone to MD in a hurry and he made it right....but another nurse on the floor is still upset to think that he would be given "that much". The only side effect that pt does not get used to is CONSTIPATION! And I got an order to help with that while I was on the phone. Have a great Holiday season...:angel2:
- 0Dec 21, '03 by VickyRN Senior ModeratorDid we read the original post differently??? Or are you not having too great a day? I am definitely missing something and refuse to get into this peeing contest....You win. Hope your day gets better...Last edit by VickyRN on Dec 22, '03
- 0Dec 22, '03 by adrienurseA 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 says give him something, and you have doctors orders. You know the pain medicine may slow the respirations down too low and you're nervous it may even stop the respirations, but you know the patient is in some kind of distress, perhaps pain (say in a terminal cancer patient who prior to this has been in a lot of pain for months). You may even call the doctor to clarify orders, who says give it now. Do you give the pain medicine?
Give the medication, we all deserve to die peacefully and without pain.
- 0Dec 22, '03 by Spidey's mom, ADN, BSN, RN GuideQuoted from Ratchit . . .
"A mentor of mine somewhere along the way told me that pain is not an acceptable way to sustain a blood pressure. That voice in the back of my head has made this situation easier for me several times."
Thank you . . . . I'll keep that thought in mind too.
Give the medication.
- 0Dec 22, '03 by kwagner_51I would definately give the med. In the late 70's early 80's, I witnessed two deaths from cancer. The pt. was not given MS. WHY??? Because the dr. was afraid he would get ADDICTED!!
Give me a break, the person is DYING, and if he gets addicted, WHO CARES??? When my FIL died of cancer, [in 1990] he had hospice. The hospice Nurses gave him as much morphine as he needed. The dr. wasn't worried about addiction, he wanted to relief PAIN!!
The above is one of the reasons it took me so long to get into Nursing. There was NO WAY, I could work with a pt. knowing I had the relief they needed but NOT be allowed to give it, because they might get addicted!!
I have been in severe pain and all I wanted was relief!! I even told one ER doc. that if he didn't allow his nurse to give me relief, then I would do it myself!! :imbar I had no idea how to give a shot, but I would have done it.
PLEASE PLEASE PLEASE give the pain med as ordered. The pt. will be eternally grateful.
- 0Dec 22, '03 by Sheri257Originally posted by VickyRN
The 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.
Two nurses are facing manslaughter charges after giving a sedative, without doctor approval, to a terminal patient -- who died as a result.Last edit by Sheri257 on Dec 22, '03
- 0Dec 22, '03 by NursePaulaI absolutely stress that an MD order has got to be in place...and it has to be followed to the letter, I think that many nurses are afraid because of these things but even if a pt does not die, not following MD orders and giving meds without them will cost your license...The hospice that I worked for would not take a certain MD pt because he gave Tylenol Extra strength for cancer pain and would not change...so we would get them another MD that would take proper care of them. Also nurses need to keep in mind that there is a Medical Director that these kind of things can go up the chain of command to and I have had that MD a few times order meds for a pt. Usually for a MD to go against another it needs to be serious but I have seen it happen several times. Also with the pt and their families becoming more educated I believe that we will see more lawsuits about NOT managing pain and especially terminal pain....