Is everyone afraid to give Morphine?

[prostreetrig]

Hi there. I am employed with Hospice in my area and one thing I have noticed is as soon as we introduce MSIR or Roxanol families flip! They all do the reading and figure that Morphine will stop someones respirations. I have done so much teaching regarding the safe use of the drug and still people are afraid. We had a gentleman in the dying process with lung ca and bone metz. He was in so much pain and was taking Methadone, Fentanyl, and some other pain meds. As soon as we brought in the MSIR the family freaked. It got so bad that when he was actively dying we had to do continuous care because the family was afraid they would give him the Roxanol and he would take his last breath. Is this common in everyones area or are people just really that scared? Let me know what you have run in to.

[globalRN]

Absolutely,

it is cruel to allow terminal patients to suffer unnecessarily.

almost all terminal patients can have their pain treated adequately.

for those difficult cases, we call in the experts in palliative care.

decadron also can help in conjunction with opoids

[bethem]

I am a new grad; there is a lot I don't know.

My first rotation as an RN was in oncology for 5 months. I became quite comfortable giving massive doses of morphine, OxyContin, fentanyl and other opioids.

On surgical, a rather large 23 year old girl with no comorbidities was admitted with cholecystitis. She was charted PRN morphine 5mg IV. I gave her 2 doses during a 10 hour shift, 4 hours apart. I gave it slowly and safely. I checked on her to make sure she was breathing and everything afterwards.

The next morning, the 'pain nurse' had kittens because I, a lowly new grad, had dared to give morphine IV! Did I KNOW what that could DO?

Uh, yes, pain nurse, I did.

I am glad my first rotation was onc, because I am not afraid to treat my patients' pain and advocate for appropriate pain relief regimes.

[clemmm78, RN]

That's where our job is so important - education.

[Conrad283, BSN, RN]

I agree with those for giving the medications. What's the quality of life without it? Would you rather someone die in pain, or in peace?

To die a slow death is painful enough in itself. So why not?

[blueberrybon]

I'm taking care of a late stage cancer patient who is on IV Fentanyl PCA continuous with bolus (I can't remember the rate off the top of my head, it was just increased), 20 mg Methadone PO QID, a Fentanyl patch, and MS 10 mg SL Q 1/2 hour PRN.

Just withing the last few days, she is needing to have a bowel movement (or feeling she needs to) almost constantly and will sit on the toilet for 5 minutes straining to the point of sweating from head to toe. She is not eating enough to even have a bowel movement and I think the sensation is from the cancer masses.

She is starting to sleep more often, but for the frequent desire to use the bathroom. When she is awake, she repeats over and over "I'm in pain".

I give her the MS as often as she needs it without hesitation.

My question is how do I help her now? What else can I do? I feel so lost for ability to make her comfortable, I rub her lower back when time permits but am at a complete loss for words of comfort. Her husband stays in the room with her, he has a cot. I don't know what to say to him either.

Believe it or not, she's a full code per her desire. I wonder if I will be on shift when her body decides to finally go, and will have to do CPR on her. If I do, I'm going to feel guilty for helping to continue her agony/suffering.

Blue