What to do??????????secretions..... - page 3
Ok, i've only been back in hospice for 3 months, but I have questions... 10 yrs ago, when I did hospice, our agency had a portable suction setup so should a patient be unable to handle secretions,... Read More
Feb 24, '08Occupation: Hospice Case Manager Specialty: Ambulatory Care; Hospice ; From: US ; Joined: Nov '07; Posts: 9; Likes: 16I think educating & prepping the family is also key to managing secretions. I always explain to the family that secretions are usually heard on expiration & don't mean the Pt is struggling to get air in... it's just "noise". I tell them that we will try to dry them up but sometimes nothing helps & that it doesn't bother the Pt. Once the family understands, they panic less when secretions occur. I am not an advocate of suctioning unless the family is adamant about it. But I will explain that swabbing out the mouth with spongettes is usually just as effective in clearing the "reachable" secretions in the mouth. Suctioning is uncomfortable & deep suctioning to really get the mucus is worse.
I have used nebulized Morphine for Pts who are SOB rather than for increased secretions at EOL. The Morphine we are instructed to nebulize is the injectible form, without preservatives. It must be kept refrigerated after opening. The family is taught how to draw it up & utilize in the HHN.
For an actively dying Pt with secretions, SL Morphine, Lorazepam, Levsin or Atropine along with positioning, as you all mentioned, have been most effective. However, sometimes nothing takes the "death rattle" away except a celestial discharge.
Feb 24, '08Occupation: RN Joined: May '99; Posts: 3,488; Likes: 119Celestial discharge. Great term.
Feb 28, '08Occupation: HOSPICE ADMINISTRATOR Specialty: 10 year(s) of experience in HOSPICE,MED-SURG, ONCOLOGY,ORTHOPAEDICS ; From: US ; Joined: Feb '08; Posts: 99; Likes: 87Atlanta RN
I agree with all others, the essential goal is patient (and family) comfort. if your clinical coordinator is upset that you spent 4 hours on symptom control----shame on her!!!! She should be supporting your efforts. We start scope patches only if the patient is just starting the process with congestion (they can take up to 24 hours to kick in) Levsin is often a quicker alternative, and you have to stay at bedside and get aggressive with it at times. Encourage the MD to give you wide parameters to control symptoms. My staff are excellent with symptom control, but I admit that I have never used nebulized Lasix for these symptoms--I would be very appreciative if someone knows dosing parameters. We have utilized nebulized dilaudid with good results as it controls some very severe dyspneic symptoms from those with tenacious secretions.
Mar 21, '08Occupation: hospice RN Joined: Feb '06; Posts: 23; Likes: 2I would like to hear more about the aerosolized lasix. THis is new to me. How does it work. DOes it come pre-packaged. Any evidenced based articles? I am asking only because we use everything else mentioned here but sometimes we are still stuck with heavy secretions that don't want to move and sound awful -- I'd love to introduce the idea to our docs who are usually open to new ideas, but I need more info. Thanks.
Mar 22, '08Occupation: RN Specialty: 8 year(s) of experience in hospice ; From: WI, US ; Joined: Jul '04; Posts: 175; Likes: 11we dont suction either. too invasive as well as the fact the secretions will just come back. plus, usually the secretions are deep airway, not upper airway. sounds worse than it is. scope patch on at first sign of secretions works well usually.Last edit by hospicemom on Mar 22, '08
Mar 29, '08Joined: Jun '04; Posts: 62; Likes: 7i just got the royal ream out for using roxanol via nebulizer - any experience any one?[/quote]
I'm home health-NOT Hospice. Although I must admit there are times I wish I was(because I sure needed to be). I have patient that refused Hospice due to lack of understanding (that seems to happen alot and I always try to educate to allow patient to make INFORMED choice). Severe COPD, TPN via pump, bed sores etc etc etc......MD informed patient and family less than 6 months..Anyway primary MD ordered roxanol 10mg EVERY HOUR prn for breathing via nebulizer-works wonders physically and psychologically for patient and breaks the increased SHOB -increased anxiety and vice versa cycle.
Mar 31, '08Joined: Mar '08; Posts: 2Hospice is about comfort care, and someone dying on their own secretions, is NOT comfort. You did what is best for your patient. Another thing that may help is Levsin and we also use Atropine eye drops (but give them sublingually) it really works. Works a lot faster then Scoplamine which can take 4-6 hours to start working, and by then patient too congested, or has died.