Need advice about care of a consumer

[mttzakr87]

Well I am a student nurse and I am obviously not lisenced yet and pretty much everything ive learned so far is strictly the basics... and I am far from the seasoned vet who's accostomed to all types of situations.... Here is my problem: My workplace outside of school is a group home for developmentaly disabled and I have a client who has stage 4 lung cancer, who also is near passing on.....we expect it to happen in a matter of days. He is obviously uncomfortable, and is 100% disorientated and delusional, and communication is almost impossible, and having a very rough last few days. He recently just had his catholic last rights read and basically all we can do now is keep giving him his methadone prn and morphine for shortness of breath prn, and make him as comfortable as possible. Our facility is not a health care facility but a human service agency that has some sites that have extreme medical needs like mine, and basically the houses are staffed with unlisenced assistive personel, whom carry out nursing duties under the RN's lisence.... but in regards to this consumer.... is there anything else we could be doing for him at all, that we havent already done to help him ease his decline? Or have we truely done all we can do? I am a student nurse and the only person in my facility aside from the house LPN who has any remote medical training what so ever and really couldnt help but wonder if there was anything more we could or should be doing? I almost feel like my facility doesnt have the resources to handle this but we are making do.

[DixieRedHead, ASN, RN]

Not sure about your state, but where I live, in North Carolina, anyone, and I mean anyone can do a hospice consult. I think perhaps that is where you might want to think about starting.

[systoly]

Is hospice an option for this patient?

[systoly]

looks like Dixie is the faster typist

[MunoRN, RN]

Sidenote; are nursing schools teaching students to call patients "consumers" now?

[AlsgalRN]

Hospice is giving good care to my husband who is losing the battle with ALS. I think you should give them a call.

[Merlyn]

What can Hospice do in a few days or a week. If the patient is in the condition described above then there is nothing more. The cruel fact is he's dying. As much as we don't want to admitted, he's dying a horrible death. The hardest thing is to stand there and watch it, know you can't do a thing about it. I had to watch my father die from cancer. It was not pleasant. I wish you well, Sweet Soul, and for the patient a quick release from his pain.

[Merlyn]

Hospice is giving good care to my husband who is losing the battle with ALS. I think you should give them a call.

Sorry about your husband, but from working the developmental disable patient. He will not understand the treatments, he'll pull out any IV needle and really it is not her job to call hospice. It's the Home's job, she can talk it over with her supervisor

but that's it. They question of money comes up. Sorry. We all want to help but all she can do is suggest.

[TriciaJ, RN]

Hospice can be a godsend, even at the last minute. It should be fully covered by medicare if the patient has less than six months' life expectancy. The hospice nurse can come out and let you know if there is anything else that can be done to make the patient comfortable. He/she can also provide emotional support to the staff and be an all-around trouble-shooter.

Please suggest this to your management asap. And good luck to you.

[Fiona59]

Hospice/Pallative consult is definitely in order. Especially when it comes to the pain management.

Why does he need an IV? Could HDC work instead and be run at night when he's resting to hydrate him?

Morphine can be given many ways other than IV. Does he have a loxapine order?

If he is as uncomfortable as posted he really doesn't have long to go and deserves to die with comfort and dignity.

Consumer??? I know American healthcare if for profit but Consumer???

[leslie :-D]

it's hard to give advice, not knowing dosages and frequency of morphine.

i have a hunch, it's not near enough.

also, he needs ativan or some type of anxiolytic.

i think someone needs to call his dr. and explain how he's suffering. (have dr. order hospice STAT).

in this day and age, there is no reason for this to be happening.

unless you can get hospice to come stat, it sounds like this pt has veyr little time left.

other than that, get this pt long acting morphine bid, and short acting q2h prn...plus the ativan, 1mg q3-4 hrs.

again, no darned reason for this.

op, do what you can please...and thank you.

leslie

[leslie :-D]

What can Hospice do in a few days or a week. If the patient is in the condition described above then there is nothing more. The cruel fact is he's dying. As much as we don't want to admitted, he's dying a horrible death. The hardest thing is to stand there and watch it, know you can't do a thing about it. I had to watch my father die from cancer. It was not pleasant. I wish you well, Sweet Soul, and for the patient a quick release from his pain.

i am especially sorry that your father didn't die well.

but there is plenty that can be done, if people proactively seek help for this pt.

there isn't any reason to stand and watch someone suffer, w/o trying to get him help.

and i agree with you, it is horrible to watch.

that is why someone needs to do something...anything.

and that is what the op is trying to do.:redpinkhe

leslie