morphine drip for "comfort"

[melisgood]

What is your view or experience with taking care of a patient on comfort care when you know the family and doctors are trying to assist the patient in dying? I took care of a patient who was on a morphine drip. He was a young trauma patient and the ventilator had already been removed and he was a DNR. The order was to increase the morphine every hour as needed by 2mg/hr. The family was requesting we increase it every hour or two (while they were at the bedside) and he did not have any obvious signs of increased pain. At the end of my shift he was up to 74mg/hr! The doctor did put a max dose of 80mg/hr.

On one hand I understand the family wanting to end their pain of seeing their loved one like this, but on the other, I felt like I was assisting in killing this patient. What would you do?

[lmccrn62, MSN, RN]

The patient dies from their illness not the morphine. You are not hastening their death. It's hard for us as nurses to understand but it is our role as the nurse ensuring our patient does not suffer while dying.

[Pangea Reunited, ASN, RN]

Under those circumstances, I'm happy to comply with the family's wishes. I find it much more disturbing when a family doesn't want a dying patient, who is obviously suffering, to have "too much medication".

[Sun0408, ASN, RN]

If you were assisting in his death, he would have been gone long before you hit 74mg/h. Morphine has no ceiling dose. It does much more than just decrease pain, it also decreases the "air hunger" feeling.

[MunoRN, RN]

There is a difference between titrating up a morphine drip because the patient is still in pain or uncomfortable, and titrating up the drip because the patient is still alive.

While morphine is probably less likely to hasten death than many Nurses believe, it can still most definitely hasten death at supra-therapeutic doses. I hope nobody actually believes that a morphine drip at 74 mg/hr can't kill someone.

[KelRN215, BSN, RN]

I once had an 8 yr old who was on 100 mg/hr of morphine at the end of his life with 10 mg bolus doses available, I believe, q 10 min. This was in addition to continuous ketamine and relatively high doses of ativan (higher than I'd ever given before). Morphine is titrated to effect and, as long as the dose is escalated appropriately, it's not going to kill the patient.

[Sun0408, ASN, RN]

I've had AAO pts on dilaudid 3mg/h and 3mg/q6minutes via PCA. This person is very much alive and tolerating the PCA very well sitting up in bed eating and talking..This person is not on comfort measures.

[Evangaline]

No matter what way I look at the situation I would feel I was assisting a patient to their death. We all know what morphine decreases respiration in a situation like that I would pray and as the Holy Spirit for His help.

[Esme12, ASN, BSN, RN]

No matter what way I look at the situation I would feel I was assisting a patient to their death. We all know what morphine decreases respiration in a situation like that I would pray and as the Holy Spirit for His help.

But should your discomfort with end of life care interfere with that patients care? No it shouldn't.

As long as their B/P is tolerant I would increase the drip. There are far worse things than death.

[LadyFree28, BSN, LPN, RN]

Under those circumstances I'm happy to comply with the family's wishes. I find it much more disturbing when a family doesn't want a dying patient, who is obviously suffering, to have "too much medication".[/quote']

Agree.

[imintrouble, BSN, RN]

I've always hated assisting the pt to their death. It compromised some of my most basic beliefs.

I still don't like it, but a personal experience changed the way I look at the suffering and sorrow of pts and families actively dying.

I could never be a Hospice nurse, but I no longer feel opposition to any order that might change the time my pt will die.

[LadyFree28, BSN, LPN, RN]

I've always hated assisting the pt to their death. It compromised some of my most basic beliefs. I still don't like it but a personal experience changed the way I look at the suffering and sorrow of pts and families actively dying. I could never be a Hospice nurse, but I no longer feel opposition to any order that might change the time my pt will die.[/quote']

In regards to hospice, I was a hospice volunteer during my early college years; learning about death and dying prior to becoming a nurse had an effect on my views of death, dying, and comfort care, for the best.

I am one of those nurses that has a strong dislike in chasing pain, and comfort; if it is within reason, I will make sure my pts, especially hospice pts are comfortable.