MORPHINE and Dying Patients

Nurses General Nursing

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Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.

i have not problem giving morphine to make the patient as pain free and comfortable as possible. if i have an order to give 2-4mg every 2 hours i give it.

i have also had family members ask me to give whatever i can to keep their loved one comfortable.

i have also been with families that " don't want" their loved one to become additive. i educate these people on why the morphine is used and that their loved one is not becoming additive and it helps to decrease the anxiety the pt is feeling and helps them to relax and not struggle to breath. i usually spend as much time as possible educating and usually the family comes to accept that.

also, since i work 11-7, i have come into a situation where a family is upset because their loved one has been in pain and it wasn't controlled . so i will go check the mar's and if the pt can have morphine, ativan or whatever, i inform the family and they usually respond by " please just make them comfortable, use whatever is ordered".

so no i have no problem with this, what i do have a problem is with giving these types meds to drug seekers and that is a whole other story.

it just burns my behind when the family doesn't want their loved one to have so much pain medication because it snows them and they're not alert! would they rather have them lay there in severe pain just so they can see poor mom or dad 'awake'.

of course this doesn't happen very often, butr i have seen it happen. :angryfire

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i'm hearig examples of people who, for instance, were in dior pain, or who had vss.india\cating possible pain:i'm talking about neither.i read the article ,and i wonder how you prove someone is in pain,when they are unconscious?it's interesting to note,who wrote these articles, pharmacuetical companies, or what is the agenda? also, i'm a great believer that the lord planned that his people would find pain relieving drugs.i just don't believe in snowing pt's for fam. closure, or so staff can say"next".iv'e doubted studies before,that have been shown latter ti be wrong.

Please, do not take this the wrong way, but.....I would hate to think I was laying in severe agony, not being able to tell anyone and no one would give me pain meds because they couldn't "prove" I was in pain. Better safe than sorry.

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Specializes in Operating Room.
i'm hearig examples of people who, for instance, were in dior pain, or who had vss.india\cating possible pain:i'm talking about neither.i read the article ,and i wonder how you prove someone is in pain,when they are unconscious?it's interesting to note,who wrote these articles, pharmacuetical companies, or what is the agenda? also, i'm a great believer that the lord planned that his people would find pain relieving drugs.i just don't believe in snowing pt's for fam. closure, or so staff can say"next".iv'e doubted studies before,that have been shown latter ti be wrong.

There are non-verbal signs of discomfort and pain- ie grimacing, agitation, clenched jaw etc. I've noticed that most of your concern seems to be that your beliefs are being violated, and that you are being made to do something you don't agree with. However, you are not the most important person in this scenario-the patient is(2nd comes the family). No one should die in pain if it can be helped and I'd rather be a little "snowed" at the end than feel brutal pain. I would not want to see a family member like that either. Sorry, but I don't see how witholding drugs so YOU are comfortable is a very Christian idea at all. To me, it's downright cruel. Just my 2 cents.

I'm not saying this to be mean but you expressed concern that people aren't understanding what you are trying to say. Your posts are difficult to read. I know typing is not easy(it takes me 10 minutes to type a reply out sometimes) but proofreading does help.

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Well, we can ask ourselves--what is the goal, what is the expected outcome with this type of patient? What can we do to be sure we meet the goals? (These should be clearly written in the plan of care.)

With a hospice, terminal/dying patient it's pretty basic.

The patient will be as comfortable as possible (while and until, they die.)

This is really all we can do. And I think it's human nature or "nurse's nature" to want to DO something. It's very hard for some of us to not do anything.

So, we make them comfortable. We hope their death won't be long and drawn out...I don't think we should be looking so critically as to whether they might have pain or not, and UNDERmedicating if we're doubtful. They may not be laboring for breath, or grimacing or tachycardic, but they might be in agony inside there. Imagine?

And this is why I advocate for scheduled meds instead of PRN in these situations. It doesn't leave as much room for interpretation.

It's late; does this make sense?

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Specializes in ER, ICU, L&D, OR.

If I was dying, I would want morphine.Let me go with a smile, please

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i'm talking about unconscious pt,s no jaw clenching, aggitation nor grimaceing. Thank you for the studies info on morpine and cancer pain, it helps! i think the concensus here is that unconscious pts are always in pain.It seems a heck of a lot of ms04 is given by other nurses than the orders i've followed through on, i guess the lord won't hold it against me if I believe i'm assisting someone in dying but don't know it for sure.my apologies to whomever's sensibilities ive offended by not proofreading;my emotions re: the message content,was my priority. New thread idea....What is the difference between dr.kevorkian and ms04 orders for dying pt's?

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Specializes in ER/EHR Trainer.

That's easy..Dr Kevorkian and his patients make conscious choices to end their lives and their pain, whatever that may be.

A dying patient in pain, that has been given medication to help ease their passing,...depend on us, and our lack of being judgemental! You must remember morphine has no ceiling....people get used to the doses....they must be adjusted accordingly....and provided for comfort.

No one should ever die in pain if they are in our care.

Maisy;)

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Specializes in Trauma ICU,ER,ACLS/BLS instructor.
i'm talking about unconscious pt,s no jaw clenching, aggitation nor grimaceing. Thank you for the studies info on morpine and cancer pain, it helps! i think the concensus here is that unconscious pts are always in pain.It seems a heck of a lot of ms04 is given by other nurses than the orders i've followed through on, i guess the lord won't hold it against me if I believe i'm assisting someone in dying but don't know it for sure.my apologies to whomever's sensibilities ive offended by not proofreading;my emotions re: the message content,was my priority. New thread idea....What is the difference between dr.kevorkian and ms04 orders for dying pt's?

You might consider a path that does not involve ease of death and comfort of pt and family. Just an FYI. A year or so ago, a California family sued the doc who cared for their family member for not easing their pain, and they won millions!

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Specializes in Hospital Education Coordinator.

They will die from the condition whether you give them morphine or not. Your intent is to not have them die in agony.

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Specializes in RN CRRN.

my dad died in oct. in a hospital, on a cardiac floor with copd i guess. anyway, his lasix had just been increased and his ankles were looking better. well one morning my mom goes up to the floor and finds him in distress (was no one working with my dad? i thought). she calls me in a panic and said the nurse refused to raise his oxygen above 2 liters all night. (what?!?) anyway, i tell her to put a sign next to the o2 not to lower below 3 or 4 at least, to raise it and if there is trouble to call the nsg super, and that i am on the way (the day before the dr and sw (worked in hospice many years)had told us if he went home he'd be on 5 or 6l). anyway i am on my way there in my pjs in a car that had died the day before, praying to god just to get me there to get my eyeballs on this 'nurse.' i get there his ankles are good but he has been struggling and the resp therapist is in there and he is on 6l now, but still has a lot of catching up to do. my mom tells me the following not necessarily in this order: i did the sign and the rn came in and ripped it off the wall and said "who put this up there?! the doctor would go through the roof if he saw this there." my mom tells me the rn told her "he cant have his o2 above 2l due to some (the 02) drive?," i said yes if he was just diagnosed with copd.!!!! helllloooo lungs filled with fluid/lower surface area to accept 02, needs higher concentration to be of use to my dad. yes it was very frustrating. she tells me his pulse ox was 80 to 75 % and he was struggling and the rn told my mom, "you see hes fine, hes fine." and my mom is very accurate and if she said the rn said that, she said that. (my biggest problem here is that the rn was practicing medicine-we as nurses are to treat symptoms. my dad was in distress and she did nothing. my dad was under a hospitalist dr-who is on campus at all times. all it would have taken was a call a freaking phone call) the nurse wanted to call the doc to do abgs. (at the desk the sw overheard and said "no we are not doing that to him." she is an angel) anyway mom says "we are getting another nurse. the aide said to me after the sign thing, 'you know you can request another nurse'after the rn left the room. i asked my mom if she did and she said "no before i could the resp therapist came in and said 'you are getting another nurse.' and then the resp therapist kind of gave my mom a knowing look like, yea we know she sucks.' anyway then the room was full of pp, drs (prob when she called to get the abgs ordered he saw how crazy she was-the doc was my dads fav and he loved my dad-and you just dont upset him, sw, chaplain, rts aides, new nurse (excellent) and then i see the other nurse peering in the room like whats going on? the problem here is that it turns out it was his last lucid day talking and alert. the lasix was working, but due to the distress the dr orders 1mg of morphine q hr, per pca. this was yes a godsend. he who never wanted meds woke up later -twice-and said what did they give me? that was good stuff. anyway the next day he woke up a few times and said "goodbye" and "bye". the next day he couldnt speak. we asked as we left that night if he wanted us to stay, he just looked at us (maybe he stroked?) anyway, i wanted to stay but since my car was down i decided it was unfair to my mom to make her stay with me and my brother was on his way into town to see dad. so i drove her home in her car and planned to return at 0200. we got a call at 0110 that his bp was dropping, i said well be there in 10 minutes. he died as we walked in the room. i cant get that out of my head. anyway i just feel cheated because yes i wanted the morphine, but feel it could have been put off if he had had the 02 he needed and not been in distress due to that nurse, since the lasix was doing good. i just feel like the morphine should not have been needed yet, and his last lucid day with us (morphine knocked him out and built up in him) was a struggle. that is my personal take on morphine, but dont get me wrong, if i am gonna go, or more importantly my dad, it couldnt have been calmer and more comfortable. sorry for being so long, and ill wrote, (and i have an english degree). yikes.

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Specializes in RN CRRN.

I posted above, and in response to the being snowed, we were going to have it pared the next day, but he died. The reason he got the morphine was because of the 02 ordeal. He was in distress cuz she wouldnt raise it above 2L when he should have been at 5 -but the lasix was working, and we just wondered if he would do okay without it so much, dont fault us for wanting to have quality time with him before he died, if he was still in distress, well then fire up that PCA pump again...no problem, but he had been lucid and talking, but in distress, before it was started. We just wanted to be able to speak to him...and have a PROper goodbye, that is all. See it from our side. We feel cheated. -Dont get me wrong though, I know what you mean, a pt in pain, they don't want pain meds, but the fam calls you all the time if the pt crosses their eyes. "Why is he doing that? Can you make him stop etc.?" Good Lord, if you want us to treat them, let us treat them, cant have it both ways.:uhoh3:

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{{{{{silvergirl**********

Your dad was lucky to have you fighting for him. And he got to say goodbye, anbd that "that was good stuff."

A little more time would have been good. But his last days were with you all, and pain free.

:)

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