hospice question

[amy1997]

I am a hospice nurse and have a patient with Carcinoid cancer and heart disease. He recently fell at home and recieved a humeral Fx. When he went to ER, ER MD said cancer patients should never use Darvocet which patient has been using to control pain even before falling and recieving Fx. Are cancer patients not suppose to take darvocet. We don't use it often but this patient doesn't tolerate stronger opioids. Thanks.

[Schwarte]

Hmmm we don't use it most of the time but we have had some patients use it, so I am not sure. I would google it or something and see what you come up with. Wonder why you wouldn't want to?

[Schwarte]

found this at epocrates online: (nothing about cancer patients)

contraindications/cautions .

• hypersens. to drug/class/compon.
  
• suicidal pts
  
• paralytic ileus
  
• caution if drug abuse hx
  
• caution if chronic alcohol use
  
• caution if cns depressant use
  
• caution if depression
  
• caution if renal impairment
  
• caution if hepatic impairment
  
• caution in elderly pts
  
• caution if g6pd deficiency
  
• caution if gi/gu obstruction
  
• caution if prostatic hypertrophy
  
• caution if impaired pulm. fxn
  
• caution if head injury
  
• caution if icp incr.
  
• caution if seizure disorder
  
• caution if hypovolemia
  
• caution if hypotension
  
• caution if biliary dz
  
• avoid prolonged use
  

[moonchild20002000]

Do you think it is not used because it is such a mild pain killer?

[pattyb57]

I think we don't use it because of the tylenol in it and because of the strength, yes.

[Guest296136]

We have a few oncology docs that will never give an order for tylenol or anything containing it.

[bmt nurse]

We won't use anything containing tylenol for the simple fact that it can mask a fever/infection when a patient is neutropenic. The first oral opiod of choice is oxycodone.

[tewdles, RN]

Bottom line...hospice patients take what works for them...so if a patient signs up and is on darvocet, or norco, etc and it is effective in controlling their pain we don't necessarily change it.

If we get the choice, we stay away from meds containing acetaminophen as it limits how much and how frequently we can allow dosing. Even if they are on something like darvocet we will add oxycodone or morphine as an alternative and once they begin to use it we transition the plan to eliminate the other med.

ER docs often don't know as much about hospice as they might think they do...

[JamieLeeRN]

The only reason I could think of in regards to the not wanting to use tylenol is the risk of masking the fever, as stated before. However, I do have to say that some kind of NSAID, may be very beneficial since it will most likely help a lot with the bone pain. And I also have to say I agree that the ER doc is most likely missing the whole point of hospice here...it is about making the patient comfortable, we have already come to terms with the fact that we won't be able to cure them.