MORPHINE and Dying Patients

Nurses General Nursing

Published

Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.

Specializes in Med/Surg - Pain Management.

I 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?!?!?!?

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Specializes in Med/Surg - Pain Management.

I 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.

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Specializes in rehab,geriatrics.

to milner-I am unsure of what you are asking me could you clarify?thanks

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Specializes in rehab,geriatrics.

to 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

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Specializes in oncology, surgical stepdown, ACLS & OCN.
I'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...

I work in a cancer hospital and have seen many patients in past 11years on mso4

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.

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I 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????

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Specializes in Med/Surg - Pain Management.

The 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.

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Specializes in home & public health, med-surg, hospice.

We are in the buisness of life and death is a part of it.

Twinmommy+1,

You are so right.

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Specializes in ER/EHR Trainer.

Remember 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.

Maisy;)

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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).

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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).

mia, i'm truly sorry about your mother.

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.

leslie

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I have been a hospice continuous care nurse for 7+ years and I have no reservations about it what so ever. There is nothing worse than seeing an activly dying pt in pain and uncomfortable. I sometimes wonder if we give enough. Some docs are not comfortable (Usually non hospice docs) and won't order it titrated Examp. 0.25 mL - 2mL prn Q 2 hours. That can really tie a hospice cc nurse's hands and then were caught between the family wanted and pleading for me and the case mgr RN to do something when it's all in the docs hands or the family is scared of the morphine. It is also important to remember to get ms order for dyspnea/labored breathing. Does any one really believe that the pt is going to come out of this with drug problem!:uhoh3:

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