Comfort care med protocol??

[starcandy]

70 year old pt CHF, ESRD on a vent with dyspnea , b/p 70/30 currently on comfort care only. Dr ordered ativan 4mg/ morphine 4 mg IVP . Due to the difficulty in breathing I gave the morphine dose but was leery of giving the high dose of ativan also. I as afraid of pushing him over the edge with such a low bp. I realize the vent would breath for him but was nervous giving both meds at the same time. Was I wrong in feeling this way? Is this a normal practice with comfort care only pts?

[Sabby_NC]

Comfort measure covers a wide range of medical and non medical interventions for a patient nearing death.

If you were uncomfortable in giving the dosages ordered, discuss them with the Doc. You can always start with a lesser dose and go slow for this compromised patient.

You are the pts advocate and if this patient is struggling with Dyspnea on a vent then something is wrong. Vent settings too low?

What ever the cause please give the pt the Morphine and Ativan to alleviate symptoms of struggling at this time.

If they do plan to wean then this patient will certainly need vigilant dosing to alleviate the suffocating sensation.

My worst fear as I get older is struggling to breathe.

[leslymill]

You could ask for an order to titrate up to 4mg of Ativan Q4 hrs. so if less does the trick you can hold there.

[leslie :-D]

You could ask for an order to titrate up to 4mg of Ativan Q4 hrs. so if less does the trick you can hold there.

exactly.

to randomly give 4mg of ativan in a geriatric, esrd pt is dangerous.

i'm the first one to want to appease one's suffering.

but my yrs of experience strongly tells me that 4mg is pushing it way over the edge.

leslie

[Tweety, BSN, RN]

This is what I did I gave the morphine and pt was sedated resps decreased from 30's to low 20's. It was ordered q 1 hr prn. I know the goal is to maintain comfort but I did not want to be the one to speed up her impending death. I assume terminal weaning wwill be discussed very soon.

I agree, not being the one to give the "death dose" is a tough one for many of us when dealing with the actively dying.