Pain Medicine for a dying patient ... - page 5

by Tweety

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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


  1. 2
    A few weeks ago, I held an infant in my arms as he died. He had come into this world with scrambled anatomy and had undergone two open-heart procedures, a prolonged arrest, ECMO, numerous ischemic events, perforated his bowel and bled into his brain. In the pediatric world, DNR is often very difficult to sell to the docs. This boy had been deemed "no escalation of treament" but still got the occasional epi bolus when his BP drifted too far for the doc's comfort. All of us nurses were torn by this poor wee lad's struggles. Finally, his very young parents decided enough was enough and asked for a withdrawal of treatment. They took turns holding him, then left before the final acts were performed. I came on only minutes after he had been extubated. He had been given Ativan and fentanyl to ease his suffering. He lay in my arms, warm and heavy, eyes open and gazing up at me. We rocked and cuddled for half an hour before he sighed and passed. That half hour was likely the most comfortable and peaceful of his tumultuous brief life. I feel very privileged to have been there with him at the end.

    Give the meds. Please.
    Valerie Salva and Elvish like this.
  2. 0
    Originally posted by janfrn
    A few weeks ago, I held an infant in my arms as he died. He had come into this world with scrambled anatomy and had undergone two open-heart procedures, a prolonged arrest, ECMO, numerous ischemic events, perforated his bowel and bled into his brain. In the pediatric world, DNR is often very difficult to sell to the docs. This boy had been deemed "no escalation of treament" but still got the occasional epi bolus when his BP drifted too far for the doc's comfort. All of us nurses were torn by this poor wee lad's struggles. Finally, his very young parents decided enough was enough and asked for a withdrawal of treatment. They took turns holding him, then left before the final acts were performed. I came on only minutes after he had been extubated. He had been given Ativan and fentanyl to ease his suffering. He lay in my arms, warm and heavy, eyes open and gazing up at me. We rocked and cuddled for half an hour before he sighed and passed. That half hour was likely the most comfortable and peaceful of his tumultuous brief life. I feel very privileged to have been there with him at the end.

    Give the meds. Please.

    Bless your heart, you are truly a gift among nurses......:kiss
  3. 0
    Originally posted by 3rdShiftGuy
    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 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?

    This is not a question about euthanasia, it's about pain and comfort measures. Is it going too far?

    I'd give it in a HEARTBEAT - and in fact have done so MANY times over my many years as a nurse. WHAT IF it's the last injection that helps the patient relax and die comfortably?? To me, THEN you are the ultimate Nurse. Nurses CAN'T change the outcome of a terminally pt. We CAN change the quality of life they LIVE through till they die.
  4. 0
    I had been a nurse for a couple of years and was doing temp work at a LTC facility. There was an elderly man dying and every night when I would come on at 11pm she would ask me to please give him something for his pain. I would look at the MAR and find that no one had given him his morphine for the whole day. So all through my shift he would get his pain med and his pain was under control only to start all over the next night. When I asked the other nurses why they did not give him his morphine they replied "I don't want him to die on my shift". I stayed with the job for a couple of weeks until the man passed away [ON MY SHIFT]. I left the facility and never went back. It should be a criminal offense to withhold pain meds to a terminally ill patient. Needless to say when the DHS investigated there were a lot of problems for the nursing home and the nurses that did nothing for this gentlemans pain. His wife was very upset that the DON would not make the nurses give him his pain meds. Sorry to ramble but I truly believe that terminally ill patients should not have to suffer.
  5. 0
    Originally posted by LPN_mn
    I had been a nurse for a couple of years and was doing temp work at a LTC facility. There was an elderly man dying and every night when I would come on at 11pm she would ask me to please give him something for his pain. I would look at the MAR and find that no one had given him his morphine for the whole day. So all through my shift he would get his pain med and his pain was under control only to start all over the next night. When I asked the other nurses why they did not give him his morphine they replied "I don't want him to die on my shift". I stayed with the job for a couple of weeks until the man passed away [ON MY SHIFT]. I left the facility and never went back. It should be a criminal offense to withhold pain meds to a terminally ill patient. Needless to say when the DHS investigated there were a lot of problems for the nursing home and the nurses that did nothing for this gentlemans pain. His wife was very upset that the DON would not make the nurses give him his pain meds. Sorry to ramble but I truly believe that terminally ill patients should not have to suffer.
    "Gratitude is the fairest blossom which springs from the soul".
    Henry Ward Beecher

    I am grateful you are on this planet...one more Light:angel2:
  6. 0
    Originally posted by Noney
    Give it.


    And if I'm eve the patient in the above situation:


    Give it 5 minutes ago.



    Noney
    I'm with Noney!!
  7. 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.
    This why it is imperative that MDs address living wills with pts that are terminal or chronic...We know what is the RIGHT thing to do for someone in "Aunt Mae's" state but I agree families do not always agree and can cause problems. It is unfortunate and really when you think about it, it is all about them not the patient...family members feel sad, responsible or whatever..I used to see it from time to time in the ER when families would practically come to blows while dad was laying there on a vent without any hope of recovering..

    Has anyone heard of the "five wishes" ? I believe it is put out by Florida Hospice..it is a wonderful document and spells out exactly what you would or would not want at the end..how you want people to remember you , messages you want to leave for people..My hub and I filled them out (we are mid thirties)..I don't want our kids or parents to have to make those tough decisions..it is just too much responsibility and stress in an already bad time.
  8. 0
    Originally posted by LPN_mn
    It should be a criminal offense to withhold pain meds to a terminally ill patient.
    I agree. I guess we need to press congress on this one...
  9. 0
    Originally posted by janfrn
    A few weeks ago, I held an infant in my arms as he died. He had come into this world with scrambled anatomy and had undergone two open-heart procedures, a prolonged arrest, ECMO, numerous ischemic events, perforated his bowel and bled into his brain. In the pediatric world, DNR is often very difficult to sell to the docs. This boy had been deemed "no escalation of treament" but still got the occasional epi bolus when his BP drifted too far for the doc's comfort. All of us nurses were torn by this poor wee lad's struggles. Finally, his very young parents decided enough was enough and asked for a withdrawal of treatment. They took turns holding him, then left before the final acts were performed. I came on only minutes after he had been extubated. He had been given Ativan and fentanyl to ease his suffering. He lay in my arms, warm and heavy, eyes open and gazing up at me. We rocked and cuddled for half an hour before he sighed and passed. That half hour was likely the most comfortable and peaceful of his tumultuous brief life. I feel very privileged to have been there with him at the end.


    janfrn, I have tears in my eyes. What a honor and privilege it was indeed! It's in those special moments as a nurse that makes all the ugly of the job go away. It is never easy when a patient dies, especially a little one, but to be able to ease the pain and hold him as he passed is a feeling that not many people know or understand. Thank you for taking such loving care of him, and all your patients!
  10. 1
    From ANA Position paper, published 1991:

    Promotion of Comfort and Relief of Pain in Dying Patients

    Summary: Nurses should not hesitate to use full and effective doses of pain medication for the proper management of pain in the dying patient. The increasing titration of medication to achieve adequate symptom control, even at the expense of life, thus hastening death secondarily, is ethically justified.

    Nursing has been defined as the diagnosis and treatment of human responses to actual or potential health problems (American Nurses Association, 1980). When the patient is in the terminal stage of life when cure or prolongation of life in individuals with serious health problems is no longer possible, the focus of nursing is on the individual's response to dying. Diagnosis and treatment then focuses on the promotion of comfort which becomes the primary goal of nursing care. One of the major concerns of dying patients and their families is the fear of intractable pain during the dying process. Indeed, overwhelming pain can cause sleeplessness, loss of morale, fatigue, irritability, restlessness, withdrawal, and other serious problems for the dying patient (Spross, 1985, Amenta, 1988, Melzack, 1990). Nurses play an extremely important role in the assessment of symptoms and the control of pain in dying patients because they often have the most frequent and continuous patient contact. In planning nursing care of dying patients, "the patient has a right to have pain recognized as a problem, and pain relief perceived by the health care team as a need." (Spross, McGuire, Schmitt, 1990).

    More info:
    http://nursingworld.org/readroom/pos...ics/etpain.htm
    jlivermore likes this.


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