Pain Medicine for a dying patient ... - page 3

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

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    Thank 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:

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    I forgot to say that pain is a natural antagonist to the resp. depressant effect of narcotics.
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    Did 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...
    My apologies for upsetting you, Nurse Paula. What I was trying to say was you need to be very careful in treating a terminally ill patient if the family is not behind you--especially if the patient is a full code. When I was working in a level III ICU (not TOO long ago), we encountered this situation which I described fairly frequently. Families disputing about code status, insisting "EVERYTHING" be done and the patient suffering in a sort of "no-man's" land. Can't be kept as comfortable as should due to "full-code" status. Instead of dying in peace, dying with a room full of strangers with all sorts of interventions being done. It is our job to educate families, but a coding patient is a little too late--families are often hysterical. I was reading a post on the Spectrum not too long ago (the Shady Grove Adventist case, I believe) in which a nurse's license was suspended, her name plastered all over the newspapers, and the nurse taken to court. One of the allegations was a family stating their DYING relative was given a "pain shot" by the nurse and the family member died immediately afterwards. We live in a crazy, litigious society and nurses have to be very, very careful.
    Last edit by VickyRN on Dec 22, '03
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    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 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?
    You're describing my day to a "T"

    Give the medication, we all deserve to die peacefully and without pain.
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    Quoted 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.

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    I would absolutely give the pain med. As so many people have commented, it is the intent.
    I have worked Oncology for almost 28 yrs--even before Hospice, and it has always been the intent that is the key.
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    I 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.
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    Yes. Yes, I would give the med.
    And I would hold the hand and mop the brow. If death happens to follow them getting medicine, then so be it. At least they aren't going out moaning and writhing in pain, they are going quietly and peacefully...without pain.
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    Originally 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.
    A similar situation is happening out here in California.

    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
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    I 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 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....

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