Quote from nosonew
Okay... new hospice nurse (RN since 93 however) and having difficulty transitioning from curative to palliative care. (imagine that!)
Pain control: What do you most commonly use? Do you ever fear using too much Roxanol? How do you explain the difference between Roxanol and Morphine Sulfate? Our Medical Director tells me they are TOTALLY different drugs. Yet they are both MS, so I do not understand this. Yes, I know Roxanol is stronger... but that isn't what he meant.
Bowel regime: What do you do when you get a patient (new admit) and apparently he/she hasn't had a bm in 7-10 days? (eek!) Is unable to tell you.. and facility he has been at "hasn't paid attention?" (eek!) What would you have done? Ordered?
Skin Care: What products do you use most frequently for skincare and decubs?
Last but not least... (boohoo) HOW do I get supplies that I would LIKE to use, but aren't on in stock (perhaps expensive)??? And I work for a non-profit... (eek!) Help!
morphine is probably most commonly used.
roxanol is the manufacturer name for morphine sulfate concentrate.
it only comes in 20mg/ml.
but there is also a generic morphine sulfate concentrate, 20mg/ml.
they are NOT totally different drugs but morphine sulfate comes in different concentrations and can be given po, pr, im, sc, iv.
roxanol is only po/sl.
if pt is in pain, i do not worry about giving increased dosages.
but yes, it is possible to administer too high of a dose initially.
you would not start a pts' first dose of 50 mg, yet 50 mg is certainly not an unreasonable dose once lower dosages have been unsuccessful.
no bm x 7-10 days?
goal would be immediate evacuation then establish routine bowel regimen.
higher dosages of narcotics require more aggressive bowel regimen.
routine skincare would reflect needs of pt.
unscented is preferable.
as for decubs, depends on stage and presentation.
stage I, II, III or IV?
infected? eschar? fungating?
as for preference of supplies, you can always talk to facility wound/skin consult but they usually have their own established set of supplies.
you can always try and market the ones you like, with data to back it up.
but other than that....
i have frequently brought in my own skin cremes/lotions, as long as it is maintenance/routine skin care and doesn't treat anything medical.
have you been oriented already?
if you haven't, please, ask any and all questions during your training.
best of luck.