Pain Medicine for a dying patient ... - page 7

by Tweety 25,048 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


  1. 0
    Quote from Tweety
    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?
    No... I do not believe it is going to far. The patient is terminal and relieving the pain is essential for quality of life. If the patient dies of a morphine overdose atleast they are not in pain and that is all that truly matters.
  2. 2
    Quote from 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.
    If I am ever the parent of a terminally ill child, I want you to be his/her nurse.
    KimberlyRN89 and Simplepleasures like this.
  3. 2
    Quote from Arwen_U
    If I am ever the parent of a terminally ill child, I want you to be his/her nurse.
    I would be honored. But God forbid we ever get there.

    He's on my mind a lot these days as the 4th anniversary of his death approaches (next Tuesday). I can still see his little face and feel the weight of him in my arms. That night I truly felt like I'd done something worthwhile.
    KimberlyRN89 and leslie :-D like this.
  4. 0
    Quote from ratchit
    Unless they've withdrawn it, the ANA has a position paper stating that providing comfort measures including meds for dying patients is NOT euthanasia, even if that treatment or med hastens the death of the patient. The difference is the intent- are you planning on promoting comfort, with death being a known risk, or are you planning on killing them?

    I am not OK with actively killing someone. I am absolutely OK with giving morphine, ativan, or whatever to promote a dying patient's comfort, no matter what happens next.

    I see it as one of the most honorable things I can do as a nurse- provide comfort at the end. Their cancer killed them, we just make them comfortable. If the patient is competent to do so, ask them what they want.

    (Except for that serial killer in KY of course- he deserves to be tarred, feathered, drawn and quartered.)

    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.
    Exceptionally well said!!! THANK YOU THANK YOU

    --a hospice nurse
  5. 0
    Quote from Tweety
    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 just wanted to point out something here, if this person has been in pain for months, they are not opiod naive and less likely to have a decrease in respirations.

    I agree with everyone else, I would definately give the meds! It is the only compassionate thing to do.

    Cheryl
  6. 0
    Quote from dphrn
    With the scenero stated, I would provide the pain medicine without hesitation.
    Me, too.

    I have been in similar situations. The goal is to have the pt on routine dosing, and have pain and sx managed way before the pt is actively dying. This way, there is no "big dose" needed near the end, just continuation of the routine dosing. Meds are titrated as needed, so a pt wouldn't be getting a large dose of meds that their body was not accustomed to. Their routine dose would not "push them over the edge" towards death.

    This way, there are very slight to no signs of distress, or adverse side effects from meds at the end.
  7. 0
    I just wrote a paper for my MSN concerning medicating the dying patient. In my research I have found that most times clients do not receive adequate symptom control at the end of life. I am a hospice educator and I will tell you this you must as a nursing professional advocate for your patient. Advocating for your patient includes medicating them for pain and keeping them comfortable.


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