Pain Medicine for a dying patient ...

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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 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?

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  3. 66 Comments...

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    Unless they've withdrawn it, the ANA has a position paper stating that providing comfort measures including meds for dying patients is NOT euthanasia, even if that treatment or med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.
    sharlynn likes this.
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    The same thing was taught in my bio-med ethics class. There is always a *final dose.* The intent of that dose defines whether it's pain relief, euthanasia, or murder.
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    With the scenero stated, I would provide the pain medicine without hesitation.
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    Absolutely, give the med.
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    Give it.

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

    Give it 5 minutes ago.

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    During the first year out of nursing school,I took care of a patient who had tried to die a couple times and ended up in ICU before the family finally decided to let him be a DNR. He had lung cancer, and the family had a hard time accepting that he was terminal at first. He was transferred out to me from ICU and was actively dying at that point. I went to give him an MS push to calm him...he was just wild trying to get air, but wasn't conscious. What a learning experience that was!
    But I gave him the MS and he died while I was standing at the bedside. Just like that. It took me a while to mature as a nurse to understand that I had not actually killed the man. I think a lot of nurses worry about that when they are giving huge doses of MS to terminal patients.
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    I think that the simple fact that you're questioning whether to give the pain medication in this situation shows that your intent is to do what is best for this patient. It also shows the execllent skills you posses as a nurse.

    As to answer your question, in this situation I would in no doubt administer the medication. I would in no doubt ORDER the medication.

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    Thanks for the input. I would give the medicine, and have before and will again. I'm encouraged to know there are others like minded people, and I hope I get a nurses like you guys when my time comes.
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    The hospice that I worked for had a saying, "They finally got comfortable enough so they COULD die". If a pt is actively dying and in obvious pain I think it should be a crime not to give pain meds at that time...also if they have been taking it for a while a dose at this point is not going to suppress their respirations further...

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