Morphine and comfort care.

SaoirseRN · Aug 4, 2013

It's not necessarily the morphine that makes them "sleep". That's part of the dying process, and while yes, morphine is a CNS depressant, often what it does in end of life care is make their rest more comfortable. More restful.

Morphine doesn't make them die. They are dying already. Can it hasten death? Yes, it can, but it does not cause their death.

To answer your question, every person is different. People can be on morphine or other narcotics for hours, days, even upwards of a week before they pass.

Sun0408, ASN, RN · Aug 4, 2013

Morphine is used for pain control and to make a pt more comfortable re resp distress etc, with that said many pts are on morphine long term months before they pass. In an acute setting, a morphine gtt is not uncommon. I however have not seen it hasten a death but rather make the pt more comfortable once they hit the actively dying stage..

Can you explain a little more, I'm kinda confused as to what you are asking.

Personal story, my aunt was 44 year old with CA, she was on morphine and ativan for months before she passed, shortly before her death she was given a dose of both the ease her air hunger and suffering. The medications eased her passing, the CA is what killed her.. Also I have seen CA pts on 2mg diladid qh with 1mg q6 minutes on their PCA or as little as 0.2mg an hour of morphine with a demand dose of 0.2mg q6 minutes.

SuesquatchRN, BSN, RN · Aug 4, 2013

I've known folks with COPD on it for years.

Caffeine_IV · Aug 4, 2013

Weeks, months, years. Morphine is common in hospice for respiratory distress and pain. The rate at which someone dies depends on much more than the meds they receive.

We do give higher doses and frequencies than other settings but it is very necessary.

NC29mom, ASN, LPN, RN · Aug 4, 2013

Sometimes morphine can actually PROLONG a pts life.....allowing them to be more comfortable (for those suffering in pain, or gasping for breath).

As with any medication, morphine has to be used properly, so educating the families is extremely important.

Alnitak7 · Aug 5, 2013

Thank you to all who helped answer my questions.

I have been told that morphine "facilitates the dying process," but I always suspected there was a lot more to it than this.

dansamy · Aug 5, 2013

It facilitates death in that the patient is more peaceful, restful, fights less. That's what people who have said that to you have probably meant.

hospicechpn · Aug 18, 2013

We had a COPD patient come on service at our hospice who had a bed-to-chair existence due to debilitating dyspnea. After she started morphine she gradually increased her activity level until she no longer met hospice criteria. She discharged from hospice and lived several more years. Morphine was instrumental in her comfort and quality-of-life.

saflynn · Apr 21, 2015

I have a resident who has end stage COPD and is on scheduled Morphine 5 mg TID and PRN Morphine 10 mg every one hour.

Also has scheduled and PRN ATivan 1.5 mg every four hours. There are days when this person takes PRN MS hourly on top of the scheduled.

Continues to smoke. Uses his electric wheel chair often times is unsafe. Has additional meds though not critical to his diagnosis. I'm curious if he is receiving too much morphine. He is on Hospice. Is this the best way to approach comfort for this person or is there something else that should be implemented to provide comfort care. His biggest issue in my assessment is anxiety. Anxiety over the dying process and not wanting to be alone.

NC29mom, ASN, LPN, RN · Apr 21, 2015

I have a resident who has end stage COPD and is on scheduled Morphine 5 mg TID and PRN Morphine 10 mg every one hour.
Also has scheduled and PRN ATivan 1.5 mg every four hours. There are days when this person takes PRN MS hourly on top of the scheduled.
Continues to smoke. Uses his electric wheel chair often times is unsafe. Has additional meds though not critical to his diagnosis. I'm curious if he is receiving too much morphine. He is on Hospice. Is this the best way to approach comfort for this person or is there something else that should be implemented to provide comfort care. His biggest issue in my assessment is anxiety. Anxiety over the dying process and not wanting to be alone.

Can you explain why this patient's PRN dose is TWICE the strength of the scheduled? Just wondering....Usually "Short-acting opioid doses are approximately 10-20% of total 24-hour scheduled opioid dose (eg, 24-hour scheduled morphine totals 150 mg, therefore give short-acting morphine 15 mg PO q1h PRN for breakthrough pain)."

I always look at how frequently the patient is using their PRN pain medication. If they are using more than three times in a 24h period, I adjust their scheduled dose strength. My goal, as their nurse, is for their pain to be managed with their long acting morphine, only using their PRN (short acting) pain medication for breakthrough pain.

I look for signs of sedation, as far as monitoring if the patient is getting "too much morphine". If your patient still functions, speaks clearly, etc., then NO he is not getting "too much". Sometimes patients will take more pain medication to ease their depression, and sadness. It sounds like your patient may have some depression related anxiety. There are some good anti-depressants that also help manage anxiety. Sadly we all know anti-depressants take forever to be therapeutic, which is a downfall.

Sometimes, just increasing the hospice team member visit frequency will help ease agitation, anxiety, and depression. And, you could see him more frequently and see for yourself if he is getting "too much morphine".