Pain Medicine for a dying patient ... - page 4

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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    This comes from my 22 years of Oncology practice. I have started more morphine drip than anyone can imagine.
    First of all most lingering deaths can be horribly painful. Many end up dying of starvation. In starvation, the eyes burn, the bones ache, it is quite miserable. The patient doesn't have the ability to speak, the are at a point when they can no longer speak, the just "feel"
    Morphine takes care of the bone aching pain and the burning eyes. It also makes it easier to breath as Morphine is the ultimate cough medicine. I lowers the peripheral resistance of oxygen and air passes in and out easily.

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    Originally posted by lizz
    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.

    the article has a seriouly stupid flaw
    Burbank police Sgt. William Berry said the nurses, "administered a sedative to make him more comfortable. But this was a particular type of sedative that required a doctor's approval. And it was administered without the approval, and the patient expired shortly thereafter...Basically, (the nurses were) trying to do the right thing, but they did it the wrong way."

    But this was a particular type of sedative that required a doctor's approval.

    duh don't they all?
    Last edit by CCU NRS on Dec 22, '03
    Teacup Pom likes this.
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    After I first graduated from school, a similar situation happened to me. I was working in a LTC facility and my patient was dying and in acute pain. His VS were crap...respirations were 6. The family was sitting at the bedside and wanted me to give him something for pain. He had MS ordered. I called the doctor and explained my assessment findings...he told me to give him the MS. Again, I voiced my concerns with giving it...he said "He is dying and he hurts...give him the medicine."
    Still worried, I talked this over with the RN supervisor who said..."give it, he is dying."
    I was in tears...I was so upset, knowing if I gave the MS, that he would undoubtedly die. I just couldn't do it. I just could not accept the fact that I was killing someone by my action. The RN supervisor gave the MS and the patient did indeed die.
    This haunted me for many years.
    4 years ago, and at the age of 43, I finally came to grips with this, and now understand how smart and sympathetic both the doctor and the supervisor in the above situation really were.
    I had a heart attack. The pain in my chest and arm was absolutely unbearable. My B/P was 80/40. I would have rather died than to be in that excruciating pain. I was given MS, (thank God I didn't have a myself... that questioned whether to give or not), and I did indeed go into cardiac arrest. Although cardioversion and intubation suck like you wouln't believe, I will always be grateful for that pain relief.
    Now, I would absolutely give it, because letting someone writhe in pain is not ok. I've learned that I'm not giving it to kill someone..I'm giving it to comfort them.

    Of course...without question... everything must be legal and accurate...I'm not into mercy killing at all.
    Last edit by Trixxy on Dec 22, '03
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    I loved your post. It shows how any one of us can come full circle once we understand!
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    While I understand what yall are saying to a T, please keep in mind not all patients who we asess to be near death ARE DNR's, nor do they have necessarily noncurable terminal diseases.

    What Vicky and I are referring to we probably see most commonly in ICU with a patient and family in shock and crises, admittedly.

    Giving a MS dose to a full code COPD patient or a neuro patient with neuro induced respiratory depression..who also happens to be in pain...may INDEED cause respiratory arrest. I've seen it happen and I've seen nurses in tough situations because they went with their gut...'comfort'.

    Hospice and terminal patients who are DNR are a whole 'nuther ballgame. By all means comfort is #1 priority. I administered Ativan liberally to my father in hospice care, while he was near death, for comfort. I asked my mother's nurses for a morphine drip and made her a DNR when both were dying from CA.

    We have a full spectrum of considerations in our goal in bringing this up is to present a little different scenario not to be antagonistic.

    Merry Christmas all! :kiss
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    I don't think you were being antagonistic at all. If the patient isn't terminal and at the end of life, or a DNR, that changes the situation entirely. The outcome goals are different.

    If the patient wasn't a DNR then treating the underlying condition that is causing the unstable vitals, etc. must be a priority. It is sad that when we know it is end of life and comfort measures are needed but the family or doc insists everything be done (and that's another thread, becuase it's a process to come to terms with loved ones end of life).
  7. 0
    Originally posted by BarbPick
    Why did giving medication without an order come up?
    VickyRN mentioned her list of things that need to be done, including doctor's orders, or you could go to jail. I just pointed out a recent case where a couple of nurses violated that rule, and may go to jail.

    I guess that's how it came up.
    Last edit by Sheri257 on Dec 22, '03
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    a method i've used with the docs who will only give mso4 2 mg. q4h prn (and that's after much debating) is that i will tell them i intend to document in my nurses' notes, the patient's response to the prescribed dose, i.e., moaning, agitation, vs, restlessness, grimacing....whatever i assess what their effect to be. 9 times out of 10, the doctor(s) will end up asking me "what would make YOU happy" ? and as for the families, i think i've always overridden their requests NOT to medicate because i'm supposed to be advocating for the pt....usually the families' knowledge deficits can be resolved with teaching, reassurance and empathy all go a long way. i still work with several nurses though, that hesitate to administer mso4 because of perceived legal ramifications. but as my state nurse's association assured me, that yes, mso4 will hasten death but as long as the intent is to relieve suffering, then there are no legal implications.
  10. 0
    Originally posted by VickyRN
    In 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.
    That's why when we came to terms with the fact that my mother-in-law was on the verge of death, my husband signed a DNR. Her brothers and sisters didn't agree with us, but said it was his decision. Because of this decision, we were able to hold her hand and show our love for her as she departed this world. The nurses repeatedly told us how proud they were of us -- that even people older than us aren't able to see the big picture (I was 25 and he 27 -- his mother only 46).

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