meds for actively dying

[pnhopeful]

To the experienced hospice nurse...are you typically going to see ATC roxanol in someone in the active stage? My insticts would say typically, yes. Just would like to hear others' input.

[tewdles, RN]

Depends upon the symptom constellation and needs of the patient.

Each POC is individualized so you may not see that type of care...

[pnhopeful]

What symptoms are typically treated with roxanol in the minimal responsive to unresponsive patient? Rapid respirations? Grimacing? What about moaning with personal care? I would use it in all 3 scenarios, but want other's input. What point is it prudent to do ATC vs PRN?

[NC29mom, ASN, LPN, RN]

Yes, you would absolutely use in all three cases. Any s/s of pain, discomfort, or dyspnea would warrant a dose of Roxanol. Of course, your order should reflect this ....... I do not give Roxanol to Pt's who appear to be comfortable. HOWEVER; if I have a Pt who was taking PO morphine, or another narcotic, ATC for pain, then I would supplement the Roxanol to avoid the Pt experiencing withdrawl symptoms. For instance, Pt A took MS Contin ER 30mg PO BID before becoming unresponsive, and actively dying. I would educate the family (and obtain an order stating such), to give the Roxanol at least twice a day (1mL BID, or in divided doses), to at least maintain the previous level of pain managment.

[tewdles, RN]

Use the PAINAD to assess the obtunded patient for comfort. Moaning, groaning, grimacing are all evidence of discomfort.

If the patient was uncomfortable when alert, we will assume that they are locked in and can no longer express their pain when they become minimally responsive.

Always treat dyspnea, morphine is a good start.

If the patient is in a facility with staff that cannot assess for administration of prn meds then you will want to schedule the meds. If they are home with the family you may leave them prn if the family is confident that they can manage that. Empower them to provide for the comfort of their loved one.

Good questions.

[MarcyRN]

Tewdles, I LOVE all your posts. You're like a hospice guru! I have learned so much from you and just wanted to say thank you!

Pnhopeful: I agree. Use what you've got! I agree with NC29mom -- look at the symptomology. Are they having rapid respirations? Are they grimacing, especially with care/repositioning? It's there! Give it! The ultimate goal of the hospice nurse is patient comfort. If the patient is breathing 47 breaths a minute, that's not comfortable...give the morphine!

And to answer your original question, yes. Most of my actively dying patients have had roxanol administration as often as ordered (usually 5 mg q1h). Tewdles is right, though, it does depend on the individual patient's needs. In my experience, though, most people have required morphine at the end.