Turning a hospice patient in severe pain? - page 2

I am seeking the opinions and advice of some of you experienced hospice nurses :) I work nights in an ICU, and occasionally care for patients who, during their ICU stay, are changed to comfort care... Read More

  1. by   imintrouble
    I wouldn't have turned my pt if I had been in your shoes.
    When you know your pt is not going to survive long enough to get a decube, it seems pointless to cause pain.
  2. by   Creamsoda
    I agree with you, slight pillow tucks can be enough. Also why wasnt he on dilaudid/ something strong? Im sure a dead leg would be pretty painfull. Doesnt seem like his pain meds were appropriate.
  3. by   Esme12
    I'm an ICU nurse and you did the right thing. Hospice patient or not.....if he was finally rsting and pain free and he was peaceful, finally after such a horrible day.

    Let the poor man have some peace. You did the right thing.
  4. by   CapeCodMermaid
    As someone who's been in excruciating pain, I can tell you I begged the nurses to leave me alone if I were sleeping. So what if I stayed in the same position for 4 hours? I was comfortable and moving would have been agony.
    I agree with the low air loss mattress. We get them for all our hospice patients. Since he was very elderly with co-morbidities, I'm thinking the suggestion of 2-10mg of morphine every 15 minutes is too much, but round the clock pain medication works better than PRN.
  5. by   smurfynursey
    I totally agree. I took ELNEC (end of life nursing education consortium) in January and it was great! I would reccomend that someone on your unit take it so they are more informed as far as comfort care and palliative measures go.
  6. by   lovinlife11
    You did the right thing. If I were dying, hadn't slept in days, finally comfortable enough to sleep, please, please don't wake me!!
  7. by   LCinTraining
    I do agree that you did the right thing.

    I also get conflicted after having been through the Hospice situation with my father in law. His tumor was in his hip, pressing onto his groin. Movement caused both hip pain and scrotum pain. Changing his brief was excrutiating the last few days. His last day we opted to let him rest. He was actively dying anyway, but I (with our Hospice nurses and aides, but not his immediate family as they don't grieve like I do...I had to stay involved in his care) wondered about skin integrity. He was on his non affected side for about 8 hours before he passed away. When I helped the aide clean him up before the family came in, I saw that a pressure sore not only had formed, but it had blistered and peeled away. There were two. The largest one was almost the size of my palm. So I constantly deal with the mental conflict of, "did we cause him uneeded pain on his good side?" I know he was basically placed in a coma with the morphine until death, but if he could have communicated, would he has expressed even more pain than he was already in?
  8. by   CapeCodMermaid
    I'm sorry for your loss. It sounds like you did the most compassionate thing. Have you heard of a Kennedy Ulcer? They develop quite rapidly at or near the end of life despite all sorts of interventions.
  9. by   LCinTraining
    I know they explained they could develop. I watched his heels meticulously and all other boney prominences. I even insisted on removing his socks to his wife's dismay because his fever spiked at 106.9 at the end. I was afraid of him seizing on top of everything else in front of them. And oddly enough, him seizing wasn't near as concerning as him being in pain to me. But we watched him suffer extensively until the pain drove him crazy and were all one request away from giving him the gun he begged for. So the pressure sore, was tough for me to witness. I thought the Kennedy Ulcer started dark, almost levidity looking. This was reddened and a giant blister that ripped open as soon as the aide touched it to roll him. I instinctively moved her hand away and stood guard over his hip while she washed his body. Not sure why. He was dead, an didn't care at that point.

    I don't know if it was because it was him and I loved him like a father, or Hospice in itself. I realized that Hospice nurses are a special entity and that I don't believe I have the emotional stamina to do that when I get done with school. Our nurse was excellent. She was a master at talking to me on a more medical level because she knew I understood it, but to the rest of the family dumbed things down significantly, giving them what they needed to know, in terms they could understand.

    But all that to say, OP, it was a tough situation. You were in a position where protocol demands you maintain skin integrity. Where, this patient had more pressing needs. You did they best you could with what you had to work with.
  10. by   tewdles
    Just a side note, hospice does not put people into coma's with morphine as they near death. Change in level of consciousness is expected and might be exacerbated by the morphine, but the morphine did not cause it.
  11. by   LCinTraining
    Thanks for that info. Reasons why I am a nursing zygote. I still have much to learn. I do know it does make people sleepy. That's what I referred to. Thanks for the correction.