DVT conservative/comfort care

renerian, BSN, RN · Dec 8, 2002

Good question. I have never done that with a DVT unless they were dying. I would love to read others thoughts. Good thread.

renerian

Tweety, BSN, RN · Dec 8, 2002

Not even an IVC filter? That would be a simple way to treat it?

I love IVC filters, takes the worry out of DVTs of patients at risk.

I guess though you would just manage the symptoms. I imagine though they would be agressive with symptoms such as hypoxia, shortness of breath, stroke, or whatever.

adrienurse, LPN · Dec 8, 2002

Excuse my ignorance, but I don't know what an IVP filter is.

aus nurse · Dec 8, 2002

Adri, it's an inferior vena cava (IVC) filter.

From memory, and that's not so crash hot, it is done under image intensifier sorta thing...bit like angiograms. The filter literally traps the blood clots and stops them getting to the lungs.

adrienurse, LPN · Dec 8, 2002

The decision was no invasive treatments. Quality of life is already low and "hypothetical" patient is unlikely to cooperate with any such treatment (severe dementia).

sunnygirl272 · Dec 8, 2002

got adequate pain meds ordered?

is family in on the decision? and has their participation been well-documented?

adrienurse, LPN · Dec 8, 2002

At present "hypothetically" Morphine liquid 2.5mg po q4h prn. Family were the decision makers and have discussed situation X2 with doctor and day RN. Right now she's comfortable, as long as she doesn't try to walk (which btw we are not encouraging but who can argue). No pedal pulses X 2 days.

sunnygirl272 · Dec 8, 2002

Originally posted by adrienurse
At present "hypothetically" Morphine liquid 2.5mg po q4h prn. Family were the decision makers and have discussed situation X2 with doctor and day RN. Right now she's comfortable, as long as she doesn't try to walk (which btw we are not encouraging but who can argue). No pedal pulses X 2 days.

my opnion:

1) double check to make sure the family's choices have been well-documented...(CYA!!!)

2)Sheee-it..if she wants to walk...let her....

3)is the morphone liquid Roxanol? from dose, i am guessing not...roxanol is more concentrated and can be somewhat absorbed through the oral mucosa in situations where swallowing is not feasible...(ie when the hypothetical client is really near the end, yet is hurting, possibly from the CP from the MI that is occurring from an embolus....)

not meaning to be blunt..but i would want a plan in place for when it does happen, so that she does not suffer in the end...

adrienurse, LPN · Dec 9, 2002

I'm one step ahead of you Sunny.

Documentation is okay. I wasn't the nurse present at the time. Only after the fact. As a whole, the institution is pretty liberal about granting choices (it's not acute care). I just suspect that there are going to be a lot of complications.

The morphine is a concentrated oral syrop that is 2.5mg=0.5ml Should the time come whenthe oral route is no longer viable, we will be looking into other options.

sunnygirl272 · Dec 9, 2002

originally posted by adrienurse
the morphine is a concentrated oral syrop that is 2.5mg=0.5ml should the time come whenthe oral route is no longer viable, we will be looking into other options.

just to bear in mind for a potential future option:

roxanol=morphine concentrate: 20 mg/ml, 50 mg/ml...this is concentrated enought that it can be absorbe through the oral mucosa....

fentanyl patches have variable absorption based on body fat, fever, hydration.....injections are cruel in the terminal...and drips are not always feasible, esp with dementia...(as i know you are aware...)