Hospice, dyspnea, and morphine sulfate

[spaghetina]

I'm studying for the NCLEX and slightly confused about something I'm seeing on UWorld. I've had at least 2 questions about patients on hospice care with dyspnea. Both were asking what interventions to do/use in order to decrease air hunger/increase comfort in SATA format.

On one, administering morphine to decrease air hunger was incorrect, as it may hasten death. On the other, morphine was acceptable to decrease air hunger. Now, I know morphine is an appropriate drug to use, but I don't understand the discrepancy in rationales. I'm guessing that the only difference is that maybe for someone for whom death is imminent, the morphine will essentially kill them, whereas it won't have such a deleterious effect on someone who still has months to live? Is that how that goes?

I know that "NCLEX World" is not the real world, but I've had firsthand experience with a hospice nurse recommending round-the-clock doses for dyspnea and chest pain in someone who was very, very near death. So my second question is, was that an incorrect intervention, knowing that it would hasten death?

[Rose_Queen, BSN, MSN, RN]

On one, administering morphine to decrease air hunger was incorrect, as it may hasten death. On the other, morphine was acceptable to decrease air hunger. Now, I know morphine is an appropriate drug to use, but I don't understand the discrepancy in rationales. I'm guessing that the only difference is that maybe for someone for whom death is imminent, the morphine will essentially kill them, whereas it won't have such a deleterious effect on someone who still has months to live? Is that how that goes?

No, the morphine is not what kills them- it is their disease process that kills them. This is a common misconception even among nurses. Some will withhold pain medication because they are afraid of "causing the patient's death." However, based on the dosages of medication, the patient is going to die around the time of one dose or another. Perhaps the rationale for the one where morphine was deemed not appropriate is one operating under such misconception. Or, it's possible there are other parts of the question that would render morphine inappropriate and the rationale isn't clear.

[spaghetina]

Thanks, Rose_Queen. :) So, there's no case for morphine being responsible for producing enough respiratory depression in someone with respiratory compromise/dyspnea that they go into respiratory arrest?

[NICUismylife, ADN, BSN, RN]

It depends on the cause of air hunger. If they are experiencing respiratory depression, then the morphine will further decrease their respirations. However, if the air hunger is due to an acute MI, then the morphine will decrease o2 demand on the heart and help to resolve the air hunger. It all depends on the underlying cause of the air hunger. Always treat the underlying cause!

[spaghetina]

That makes sense. The only issue is that these questions were both directly related to hospice care without any further information regarding condition (that I can recall). My brain is absolutely overloaded at the moment (testing in 2 days ) though, so I'm second-guessing everything, and may be mis-remembering a critical detail.