MORPHINE and Dying Patients - page 11
Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.... Read More
Dec 5, '07Occupation: Nursing Faculty Specialty: Med/Surg - Pain Management ; Joined: Sep '06; Posts: 40; Likes: 25How do I do that? I am kinda new to this site.
Dec 5, '07Joined: Dec '07; Posts: 10; Likes: 5One of the great experiences I have had as a student nurse is working with a hospice home care unit for my community nursing rotation. This amazing group of professionals (including nurses, social workers, spiritual counselors, and expressive arts therapists) has taught me a tremendous amount about helping patients and their families live the end of their lives well. The most important lesson I've taken from them is that the dying process is part of living - and patients have the right to live that part of life with dignity and as free of pain as possible.
Dec 5, '07Occupation: Nursing Faculty Specialty: Med/Surg - Pain Management ; Joined: Sep '06; Posts: 40; Likes: 25I am able to understand the desire not to have so much tylenol. How about something like oxycontin or MS contin with a immediate release form of oxycodone or morphine for breakthrough. Then you wouldn't have to worry about the tylenol issues and may still be able to get good relief?!?!?!?
Dec 5, '07Occupation: Nursing Faculty Specialty: Med/Surg - Pain Management ; Joined: Sep '06; Posts: 40; Likes: 25I will back you up....don't skip the dose!!! If the patinet is sleeping then maybe they finally have received enough relief not to be writhing in pain. At the 6 hr mark they will be in trouble if their body is accustomed to receiving the pain med q3h. And for the person in a couple of posts ago who said something about VS - Never rely on VS. I have even had physicians tell me to look at the VS to see if the patinet is having pain. In an acute pain episode the pain may make the VS respond. However, our bodies are marvelous at maintaining homeostasis. The VS will normalize quickly. For those of you on this discussion interested in pain management go to the www.ASPMN.org site (American Society for Pain Management Nursing). Click on on the right hand side where it says The Organization, then scroll down to publications, position papers. There are some great reads there about PCA, addiction, etc ......good info for any of us who are passionate about pain management.
Dec 5, '07Occupation: supervisor-12 hr shifts Specialty: rehab,geriatrics ; Joined: Feb '06; Posts: 30; Likes: 9to milner-I am unsure of what you are asking me could you clarify?thanks
Dec 5, '07Occupation: supervisor-12 hr shifts Specialty: rehab,geriatrics ; Joined: Feb '06; Posts: 30; Likes: 9to QuestGav-you are so right about the caring people in hospice and that is the "BIG"difference I see in nursing homes/retirement communities our facility has 5 hospice organizations that come to our facility and the resident or family can pick the one they want. 5 years ago when I changed to this facility there were no hospices there.I lost my parents 7years ago dad and mom 6 years ago. both had hospice.My dad at home as he chose and my mom in the hospital because she could not make it home.It was a wonderful help to them and us so I am a real hospice fan from personal experience
Dec 6, '07Occupation: staff RN Specialty: 18 year(s) of experience in oncology, surgical stepdown, ACLS & OCN ; Joined: Apr '04; Posts: 278; Likes: 49Quote from cardiacRN2006I work in a cancer hospital and have seen many patients in past 11years on mso4I've been slightly uncomfortable with what other people might think of me when I'm titrating a morphine gtt on a withdraw of care pt. We titrate it to comfort. Honestly, I want them to look pretty darn comfortable for the family. So when I'm at 15mg an hour or more, I start to wonder if people think I'm trying to speed up the process (which, of course, I'm not).
I'm not uncomfortable with the actual act....I just want my pts comfortable, my family comfortable, etc...
gtts. they are the humane thing to do for every one who is dying of cancer and wants it. I can't stand to see my pts. in pain.:spin:
Dec 6, '07Occupation: RN, Med/Surg in Ortho/Neuro Joined: Jul '07; Posts: 1I am a quite new nurse with 6 months experience. I work on an ortho/neuro med surge floor. I definitely have an issue with giving morphine to a dying patient when I don't see any s/s of pain whatsoever... or if the patient says to me they don't want any morphine even though the family is pressuring me to give it every 2H. I am, however, not uncomfortable with giving it if I see that my patient needs it and they are showing s/s of pain (i.e. facial grimacing, movement, vitals, etc...).... My question is, what do you do when the family wants to dictate if the patient is in pain and they want the patient to have the morphine pushed every two hours around the clock, even when it's a PRN order????
Dec 6, '07The family or healthcare power of attorney have no authority until the patient themselves is unable to give input on their wishes. As for VS as a guide for pain management...NO ! Please don't use that as a tool for pain assessment. It is a very poor indicator. For an acute episode of pain VS may change...but once they have had the pain for a while the VS quickly normalize. Even if the patient is not stating they are having pain what about restlessness, moaning, air hunger? Morphine is especially good for air hunger which many patients experience at end of life. REmember that end of life care is all about making the patient comfortable and allowing them to die peacefully.
Dec 6, '07Occupation: Nurse Educator Specialty: home & public health, med-surg, hospice ; From: US ; Joined: Aug '03; Posts: 752; Likes: 97Quote from twinmommy+1Twinmommy+1,
We are in the buisness of life and death is a part of it.
You are so right.
Dec 6, '07Occupation: ER Staff Nurse Specialty: 6+ year(s) of experience in ER/EHR Trainer ; From: US ; Joined: Mar '07; Posts: 1,115; Likes: 1,673Remember morphine alleviates pain, but also anxiety, and air hunger during the end of life. As the others have said, vitals signs are not indicative of pain...especially in those who have had extreme or chronic pain.
You should never force meds on someone, nor should the families wishes override the patient's. We are there to advocate for our patient's comforts, wishes and choices-whatever course that may take. Again, it is not about us or our beliefs. It is about our patients ONLY...AND THEIR NEED.
Dec 6, '07Joined: Apr '07; Posts: 180; Likes: 93My husband and I had a similar discussion a few months ago. My mother passed away from lung cancer and during her final 24 hours or so, they increased her morphine dose to keep her from having pain. My husband said that it was like they were "putting her to sleep" like a vet would put an animal to sleep. It was really hard for me to have to watch my mom die right before my eyes, but knowing that she wasn't in any pain was a great relief to myself and my brothers. I don't think my husband will ever change his opinion, no matter how hard I try to explain it (with information I have obtained from hospice nurses).
Dec 6, '07Joined: Apr '00; Posts: 24,611; Likes: 35,453Quote from MiaKeamia, i'm truly sorry about your mother.My husband and I had a similar discussion a few months ago. My mother passed away from lung cancer and during her final 24 hours or so, they increased her morphine dose to keep her from having pain. My husband said that it was like they were "putting her to sleep" like a vet would put an animal to sleep. It was really hard for me to have to watch my mom die right before my eyes, but knowing that she wasn't in any pain was a great relief to myself and my brothers. I don't think my husband will ever change his opinion, no matter how hard I try to explain it (with information I have obtained from hospice nurses).
but i'm relieved that she died peacefully.
there's a big difference in the analogy your husband brought up.
a vet's intent is to put an animal to sleep.
nsg's intent is soley to treat pain.
we are not putting anyone to sleep.
i don't understand why some neglect to see the difference.
it's solely about one's intentions.
i watched my mom die, too.
and knowing what i did about mom's disease process, more than ever, i say, "thank God for morphine", and an even bigger thank you, to the nurses who put their pt's issues ahead of their own.