MORPHINE and Dying Patients

Bocephus71RN-BSN, BSN, RN · Nov 25, 2007

Anyone who has worked with patients w/chronic pain (terminal or not) or even suffers from chronic pain themselves, can tell you that it's far more difficult to get pain under control than it is to keep it controlled.

Very good point. I received a pt. with chronic pain my second day at work. The first night this pt. arrived he had used 90mg morphine per pca in a 9 hour period to get his pain under control. However the nurses that cared for him the first night kept insisting that he was just there to "suck down the morphine and watch TV" so the next day a covering physician who did not take the pt.s history into account. Took him straight off the morphine without titrating down or allowing any other medications to kick in to keep this mans pain under control. The man was in tears when i received him. He was in extreme pain, diaphoretic, tachypneic, and severely anxious. The man was not having withdraws from morphine over a 12 hour period, but rather withdrawals from not having his pain controlled appropriately by health care personnel by both the Doctor and the nurses, who encouraged the doctor to shut off the pca because he was there to just "suck it down". No one had listened to the mans subjective information, took into account the mans history or acknowledged the objective data. The man lived with chronic pain of 7-8 out of 10 daily for many years( related to a work related injury). And he was simply having withdrawals from not having pain relief(which he never has had completely and had only a short reprieve from the pain for a short period of time as opposed to withdrawal from the morphine itself). The man was ashamed that his kids and wife had to see him crying and I felt bad for him, because his kids hadn't seen there daddy so comfortable and less irritable in years. The little girl when she saw her dad asked " does this mean your going to be grouchy when you are at home again daddy." The man felt ashamed cause his pain had not only affected his life, but also his children, his wife, and everyone he came into contact with.

EmmaG, RN · Nov 25, 2007

I hope that was reported. There's no excuse for what he had to endure.

LiverpoolJane · Nov 25, 2007

I have a memory of a patient dying in a great deal of distress as the nurse would not ask the doctor for pain relief as "it might knock his breathing off" I was a student nurse back in 1991 on night rotation, the patient had been with us a while a heavy smoker with PVD and ended up having first one leg then the other amputated. He seemed to be over the worst of his problems and was making good progress all things considered. For whatever reason his condition deteriorated quite rapidly and after a battle it was decided there was no more we could do medically for this man and he was dying. I remember hearing him groaning in pain, we had to go into his room and change his wet sheets - wet with perspiration from his distress - and he was in agony when we went close to him. I remember the staff nurse sitting outside his room doing her knitting while he was in the most excrutiating agony a few feet away. When I asked her could we bleep the doctor and ask for some pain relief that is when she said she couldn't because it may effect his breathing - and then said "would you give it" in a tone of voice that suggested if I said I would I would be some sort of criminal. That night still haunts me to this day as I feel I should have been more assertive. I wonder if that staff nurse ever had a relative dying in pain and distress and regreted her inactions. I like to think we have come along way from that time and would never leave anyone in pain like that. The man died before my shift ended and yes giving him analgesia may well have meant he would have died a few hours sooner but he would have passed away in some comfort. Instead his family will bear the memory of that night with deep sadness instead of being consoled that he fell asleep peacefully as we all would like. I always say that sometimes we do not prolong life but we prolong death. I get satisfaction when relatives come back to my ward and thank the staff for all the care and are comforted by the fact that their loved one was so peaceful and comfortable at the end - a comfort the other familes have been deprived of.

suespets · Nov 26, 2007

feelin bad that i can't get some people to understand how i feel in this issue.i have never knowingly withheld pain meds from pts in pain.when i said i might give it q6 hr,i meant one dose,cuz the pt(btw,non-cancer)had been getting it q3, even unconscious, so i would skip 1 dose,essentially.i still feel nobody can really leave his/her belief system at the door.to me, thats living 1 depressed life,going against your values.i am familiar w/ the" feel the pain,cuz it's the lords will"thing.not one of my beliefs.i have gained some food for thought from some of these entries .will explore further. I realize even agnostics can share my feelings on this matter(not bringing christianity to it) btw:what is a 'frequent flyer',or a 'walkie talkie'?or crna?

cardiacRN2006, ADN, RN · Nov 26, 2007

.i still feel nobody can really leave his/her belief system at the door.to me, thats living 1 depressed life,going against your values.

This isn't about your values. This is about the patient. If they are in pain, then they need their meds. If you skip doses based on your values, and then 6 hours later on the next shift they are in terrible pain, then that's on your conscious.

Why withhold meds? Are the meds coming out of your pocket or budget??

pagandeva2000, LPN · Nov 26, 2007

I would have no issues of administering morphine to a person in intense pain and dying. My mother required it, and the nurses had no issues with it. I understand how you feel, though.

Let me ask, are you new to nursing? I only ask because in most cases, people who, over time, see how these poor people are actually suffering, and demonstrating by asking or even begging for relief of that horrible pain, most nurses change their way of thinking.

kukukajoo, LPN · Nov 26, 2007

Are you a nurse?

feelin bad that i can't get some people to understand how i feel in this issue.i have never knowingly withheld pain meds from pts in pain.when i said i might give it q6 hr,i meant one dose,cuz the pt(btw,non-cancer)had been getting it q3, even unconscious, so i would skip 1 dose,essentially.i still feel nobody can really leave his/her belief system at the door.to me, thats living 1 depressed life,going against your values.i am familiar w/ the" feel the pain,cuz it's the lords will"thing.not one of my beliefs.i have gained some food for thought from some of these entries .will explore further. I realize even agnostics can share my feelings on this matter(not bringing christianity to it) btw:what is a 'frequent flyer',or a 'walkie talkie'?or crna?

Shantas · Nov 26, 2007

feelin bad that i can't get some people to understand how i feel in this issue.i have never knowingly withheld pain meds from pts in pain.when i said i might give it q6 hr,i meant one dose,cuz the pt(btw,non-cancer)had been getting it q3, even unconscious, so i would skip 1 dose,essentially.i still feel nobody can really leave his/her belief system at the door.to me, thats living 1 depressed life,going against your values.i am familiar w/ the" feel the pain,cuz it's the lords will"thing.not one of my beliefs.i have gained some food for thought from some of these entries .will explore further. I realize even agnostics can share my feelings on this matter(not bringing christianity to it) btw:what is a 'frequent flyer',or a 'walkie talkie'?or crna?

I am sorry to say it but if you continue to hold on to these strong beleifs at work you can not be an effective nurse. When you take care of a patient you have to forget about what you beleive, you have to see from the patients point of view.

I used to work in a Psych hospital as a float nurse. Oneday I was assigned to a unit for pedophilies, I was not able to work there after that day, because I felt that I would not be able to care for them properly because the way I felt about pedophilia.

suespets · Nov 26, 2007

Iv'e been an lpn for 32 yrs,worked med surg,psych ,ob,ltc mostly. no pt. i ever cared for was in severe pain the next shift,and i do know this.I'm takeing courses now towards adn.

ready4crna? · Nov 26, 2007

feelin bad that i can't get some people to understand how i feel in this issue.i have never knowingly withheld pain meds from pts in pain.when i said i might give it q6 hr,i meant one dose,cuz the pt(btw,non-cancer)had been getting it q3, even unconscious, so i would skip 1 dose,essentially.i still feel nobody can really leave his/her belief system at the door.to me, thats living 1 depressed life,going against your values.i am familiar w/ the" feel the pain,cuz it's the lords will"thing.not one of my beliefs.i have gained some food for thought from some of these entries .will explore further. I realize even agnostics can share my feelings on this matter(not bringing christianity to it) btw:what is a 'frequent flyer',or a 'walkie talkie'?or crna?

Frequent Flyer: A single Patient that is seen often in an acute care setting. Example: A nursing home pt that is transferred to the ER every 3-5days for fluids and antibiotics then transferred back to the nursing home.

Walkie Talkie: A patient capable of walking and talking (Not an icu patient.)

CRNA- Certified Registered Nurse Anesthetist. An advanced practice nurse trained and licensed for the performance of all aspects of the practice of anesthesia.

Kelly_the_Great · Nov 26, 2007

I gave MSO4 to my Father while he was dying with liver cancer. Being able to facilitate a peaceful transition from this world to the next for him is one of the proudest moments I have ever had in my life.

When they are struggling and hurting ~ it's the RIGHT THING TO DO!

suespets · Nov 26, 2007

i totally agree!!!