ICUNurseG 75 Posts Specializes in MICU. Has 5 years experience. Mar 4, 2014 We usually use scopolamine patches and atropine drops for secretions, although they don't always work. If the pt was "gasping" morphine would be good to decrease work of breathing. Ativan is not a horrible choice, but I would not have given it first based on what you're telling me.
chillin4me 526 Posts Specializes in Hospice. Has 3 years experience. Mar 5, 2014 It is ok to give patient morphine 2ml every 2 hrs round the clock? Pt not responsive has shallow breathing, yelling at times and startles. Ativan intensol seems not working.
ClearBlueOctoberSky 370 Posts Mar 6, 2014 It is ok to give patient morphine 2ml every 2 hrs round the clock? Pt not responsive has shallow breathing' date=' yelling at times and startles. Ativan intensol seems not working.[/quote'] I don't work MICU/SICU, but I often request Roxanol q hour prn in addition to routine Roxanol, along with prn Ativan with my residents that have been admitted to Hospice. I lay eyes on them often, and will medicate as much as I can, when needed, even if asleep. At this point, the name of the game is comfort, and just because they appear to sleep, or comatose, it doesn't mean they are comfortable. Not necessarily pain, but comfort. ETA: If she startles and screams, even occasionally, IMHO, it sounds like her management of Morphine q 2, with the Ativan, isn't enough.One more edit for spelling, format and grammar. Wow!
chillin4me 526 Posts Specializes in Hospice. Has 3 years experience. Mar 6, 2014 Thank you for your input. Really helpful.
Here.I.Stand, BSN, RN 5,047 Posts Specializes in SICU, trauma, neuro. Has 16 years experience. Mar 6, 2014 We do Ativan IV and morphine IV or SL for pain/anxiety; atropine SL and scopalomine TD for secretions. The atropine we use is eyedrops--we just give them SL.
Here.I.Stand, BSN, RN 5,047 Posts Specializes in SICU, trauma, neuro. Has 16 years experience. Mar 6, 2014 It is ok to give patient morphine 2ml every 2 hrs round the clock? Pt not responsive has shallow breathing, yelling at times and startles. Ativan intensol seems not working.I'm not sure how many mg "2 ml" of morphine is since you don't give the concentration... But in the actively dying, you give as much as you need to to keep them comfortable. If she's screaming, and since the Ativan isn't helping, my thought is she's still having pain and I'd increase the morphine. I want to say our palliative dr. starts with up to 4 mg q 1 hr prn. If she's already maxed out I'd call the dr. and get the order increased. But yeah, no need to worry "is it ok to give this much" if she's on comfort care and not comfortable.
chillin4me 526 Posts Specializes in Hospice. Has 3 years experience. Mar 6, 2014 We do atropine eye drops and do it SL
Mborn2185 8 Posts Mar 6, 2014 Would you give your patient oral Ativan even though they have the death rattle when secretions aren't moving?
Sun0408, ASN, RN 1,761 Posts Specializes in Trauma Surgical ICU. Has 4 years experience. Mar 6, 2014 Would you give your patient oral Ativan even though they have the death rattle when secretions aren't moving?Oral as in needs to be swallowed or oral as in SL?? Many hospice pts don't have IV's and SL is the route in which they get their medications.
