Dyspnea Article

Good CEU article:

Assessing and Managing Dyspnea

http://nsweb.nursingspectrum.com/ce/ce272.htm

I've never given aerosoled Morphine. Is it like a mini-neb TX?...info please.

[SharonHopson]

I've had a couple of pts w/ orders for morphine per neb. All had a dx. of COPD. Usual dosage is 0.5mg per neb QID. Only one man used it on a regular basis . He told me it really helped him breathe easier and helped him relax. The other two HATED it. One said the after-taste was so bad it minimized any benefits she was getting from it. My other pt. said he didn't like the way it tasted and said he didn't see any benefit from it. (He's actually getting better w/o it!) I haven't noted any wheezing the past 4 or 5 visits but the crackles are still there, of course.

Hope this helped!

Sharon

[NRSKarenRN, BSN, RN]

Thanks!.

Do you give seperately or do you co-administer in albuterol neb?

[SharonHopson]

don't mix w/ albuterol. Using a filtered needle, mix the morphine w/ 3cc NS in the neb.

Sharon

[aimeee, BSN, RN]

Why do you need to use a filtered needle?

[SharonHopson]

I don't know. The pharmacy just always sends them when morphine is ordered per neb.

Probably, and I'm just guessing, because the morphine is being drawn up into a syringe and being used in a neb. BUT the morphine comes in single dose vials and sterile syringes are being used, so I wouldn't think possible contamination would be a problem. Good question!

Anyone know why filtered needles are used?

Sharon

[NRSKarenRN, BSN, RN]

If the morphine is taken from an ampule, the filter will prevent minute glass shards from being drawn into the syringe and possibly inhaled. used a filter straw when preparing mucomyst neb treatments in the 1980' ( rotten egg smelling stuff!) :)

[SharonHopson]

Of course!

Thanks,

Sharon

[aimeee, BSN, RN]

Oh sure, I knew a filtered needle for stuff from an ampule...just don't generally see morphine in ampules. I had Roxanol in my head.

Mucumyst--yes, that IS stinky stuff!

[nursechris1]

We always use nebulized roxanol. Comes in bottle with a dropper, patient can titrate as needed. I have one patient, who is a nurse, who says she would be willing to tell any skeptics how wonderful it works for dyspnea.

[Midge]

Have just spent most of the day searching Google and other sources for info on nebulized MSo4 for the pharmacist so I can get the proper stuff for my home hospice patient whose COPD is about to do him in. I used it for years at an inpatient hospice in Boston, but never had any pharm specs for it. The pharmacist was adamant about needing to know about sterility and preservatives. Reading the posts I see that even Roxanol is being used - how simple that would be! All of the reams of paper I have now with articles have NO info on which MS04 to use. Any pharmacists out there? Thanks for the help.

[NRSKarenRN, BSN, RN]

See previous thread Preservative free Morphine:

Nebulized drugs in palliative care

Some, but not all, clinicians use preservative-free opioid preservative-free opioid preparations in an attempt to reduce the risk of bronchospasm. If morphine is employed then the intravenous formulation should be used and not the oral elixir.

Includes drug delivery chart

http://www.brit-thoracic.org.uk/pdf...sPalliative.pdf

Doses initially of 5mg morphine diluted in either 2ml or 5ml 0.9% sodium chloride or water and nebulised over 15 minutes have been used. This dose may be repeated four hourly. If shortness of breath recurs in less than four hours or it the patient does not significantly improve then the dose may be increased by 25 - 30%. The maximum dose of morphine recommended is 30mg. Preservative free solutions are preferred when preparing doses as the presence of preservatives have been found to cause bronchoconstriction and bronchitis in some patients

http://www.stjames.ie/nmic/qa.html

Link has other articles:

https://allnurses.com/forums/showthread.php?s=&threadid=13494&highlight=dyspnea+morphine