MORPHINE and Dying Patients

Nurses General Nursing

Published

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

Specializes in Operating Room.

Just because someone is unconscious doesn't mean they don't feel pain. It just means that they have a difficult time expressing it. There have been cases of people under general anesthesia who appeared to be unconscious but were feeling everything. Sometimes when we are operating, it looks as though the patient is asleep, they're intubated, and when the surgeon goes to make incision, they squirm or jump(one guy tried to get up off of the table). There have been documented cases of people in comas who were aware of their surroundings. I still say that I'd rather have a patient die calmly, in comfort. that to me is dying with dignity. We're talking about the terminally ill. You denying them pain meds isn't going to cure them or win them any spiritual brownie points. It's just going to cause them to die in agony and that is something I wouldn't wish on anyone.

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Specializes in Operating Room Nursing.

As nurses we need to advocate for our patients, and yes even put our own personal feelings aside to give them the best care possible. It's not about you, it's about making your patients as comfortable as possible. I would hate to be dying and having my pain relief denied because my nurse felt uncomfortable giving me pain relief due to religious beliefs etc.

When I worked in ICU I saw a lot of patients 'suffering from horrific injuries and dying made comfortable'. One of the practices was to give the maximum amount of morphine and to position the patients with the head tilted down. Yes this probably sped up the process but i have no problem with that.

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silvergirl; I don't blane you at all.seeing whay happened w/ your dad, kudos to you! Scrubby thanks for your input oops, forgot to proof read,mea culpa! I remember how my dad was crawling around in his hospital bed, looking for 02,stuperously grabbing at call light cord,thinking it was 02, trying to put it in his nose. He was copd,so dr. was only giving 2l. I went to the nurse & told her he needed more liters,she told me I should advocate for him(dad)and insist dr. order higher. I told the Dr.";you asked me for a comfort order,now give him comfort;increase the o2,"seeings he was obviously uncomfortable. dr did increase liters/per hr.

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Do you know it was the morphine that caused him to be "knocked out???" I'm not trying to be devil's advocate here but also a little understanding of CO2 narcosis would be appropriate. Without ABGs etc, you would not be able to tell where he was at with his CO2. Increasing the O2 or placing him on Bipap may or may not have prolonged his life for a bit. I also realize you are still in the grieving process and looking back at things, etc. I watched my dad die with COPD/Cor pulmonale and he made the brave choice to be DNR/DNI. My dad only lived 4 days after admission to the hospital. First 2 days he was lucid (majority of time) and lthe 3rd day he was "in and out" on the 4th day he would occ. wake up and immediately drift back off and he passed very quietly that evening.

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Specializes in RN CRRN.
Do you know it was the morphine that caused him to be "knocked out???" I'm not trying to be devil's advocate here but also a little understanding of CO2 narcosis would be appropriate. Without ABGs etc, you would not be able to tell where he was at with his CO2. Increasing the O2 or placing him on Bipap may or may not have prolonged his life for a bit. I also realize you are still in the grieving process and looking back at things, etc. I watched my dad die with COPD/Cor pulmonale and he made the brave choice to be DNR/DNI. My dad only lived 4 days after admission to the hospital. First 2 days he was lucid (majority of time) and lthe 3rd day he was "in and out" on the 4th day he would occ. wake up and immediately drift back off and he passed very quietly that evening.

My dad was DNR. He was only on 6 liters for 1/2 hour to raise the 70%sp02 to 93%, they put him at 3L after they started the morphine, he stayed at 3 L till he died-being sedated and all he didn't need it higher-he was calm. My dad would not take ANY pain meds, ever, in his life. Not even tylenol. So yes the morphine would have sedated him severly. I am not saying he wasn't dying. I am saying that to do ABGs on a pt who had been refused his 3-4 L of 02 (and if you KNOW you are being refused that, would that not make you more anxious, plus knowing the RN was not calling your DOc? More anxiety) is cruel, knowing he had been a DNR. They had, even after the morphine started, DC'd his accuchecks. We had no unrealistic expectations. For all I know-he stroked and this killed him-who knows? Like I said He had been deprived for like 12 hours of 02 while the increased lasix had started working, that takes a toll. I am not saying he wouldn't have died anyway. And really what does it matter if it was the COPD or the Morphine-not my point--I don't feel the morphine necessarily sped up the dying process, it just was started I feel sooner than needed and cheated us out of our real last goodbyes. Again, I wouldn't have changed his having the morphine now, I just wish he had had his 02, let the higher dose of lasix work and if it hadn't then been able to get the rest of my bros here to say goodbye in time. Point was it was started sooner than needed (I feel) and he ended up being very sedated just after being unable to breathe. His last lucid moments were fighting for air - or at least knowing he had been refused 02 that he needed. And we never had complained about his nurse that night. Not yet anyway. But she was fired over it I heard, so I feel I am in the right about much of what was said. Just my own opinion, since I was there. I guess, yes I am still grieving, esp this being his birthday, so I normally don't lash out at someone, but really why must you even ask that question? I wasn't downing morphine or its use--just that it sedated him....:o Plus he only became a COPD er after bronchitis (acute) in sept--and refused ATBs--which put him in the hospital. They mistakenly, while in the hospital that time reduced his lasix to 40mg (form 80) and sent him home on that. He had CONGESTIVE heart failure, and this is really what they were treating at the time, from the Xray they had taken--at least that is what the doc said--stage 4 CHF. Anyway, he starts taking just 40mg of lasix, and yes ended up back in the hospital....whatever, anyway, YES the morphine sedated him

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Oh, silvergirl, I'm so sorry for what your dad went through, and that his birthday has coincided with this thread to dredge it all up.

Honestly, I think that blueheaven is still tring to make sense out of her own father's death in similar circumstances. I didn't read any criticism into her comment.

I just wish that we as a society would learn to accept the inevitability of death. I have seen more unrealistic families - and health care workers, nurses and physicians included ....

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Specializes in RN CRRN.
Oh, silvergirl, I'm so sorry for what your dad went through, and that his birthday has coincided with this thread to dredge it all up.

Honestly, I think that blueheaven is still tring to make sense out of her own father's death in similar circumstances. I didn't read any criticism into her comment.

I just wish that we as a society would learn to accept the inevitability of death. I have seen more unrealistic families - and health care workers, nurses and physicians included ....

I know she was not being critical and I am sorry, its just that I dont know....I really dont know...I should just go to bed huh? Sorry.

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Specializes in RN CRRN.

sorry if I went on too long, I guess it is still raw. Guess I need a break from allnurses huh?

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[[[[silvergirl]]]]

Now go to sleep, sweetie. You'll feel better in the morning.

I should take my own advice, but I can't sleep

:)

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Specializes in ortho/neuro/general surgery.

as i said ,"not to a pt. who is in noooooooodistress whatsoever!no vs sign prob, no crying out, no dyspnea!!!!!!!!!!!!!!

how can you be sure of that?

you become hospice,your talking ,you walking,your eating,your in moderate pain,

how do you know they are in just moderate pain?

you get ordered ms04,abhr& u become unconsious, getting ms04 round the clock,so the family can feel closure???

you're missing part of the point, ok, all of it

when did i become god, (or the devil)?btw, i work in a christian home.

and what does that have to do with the price of eggs, working in a religious facility? to me that would mean even more so that patients should be kept comfortable. i wasn't going to reply on this thread at all, but when you brought up that you work in a religious facility, it hit a nerve.

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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

I'm with you on this one! Burns my butt when a family member insists that Grandma get no pain meds because So and So will be visiting soon, and they want her alert! Their convenience in seeing Grandma "alert" (the inference is ALWAYS that they've traveled a long way and want to be sure Grams is waiting on THEIR timetable for the visit) always seems to come first. Cases like that, whenever familiy is out and we are able to medicate, dang it we do. Grams is "out" when Cousin Al comes to visit? Tough. He can wait for her to come 'round, or he can continue to have as much conversation as he's had with her for the last five years.

And it doesn't have to be a deathbed situation, believe me. I've had plenty of times when family members have insisted that Grandma not get pain meds because of THEIR schedules of visits, not because that unrepaired hip fracture isn't causing her agony.

Karma, baby.

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grace90; i didn't mention that i worked in a christian facility to be rightious nor haughty.folks gen think such a facility would want to preserve life no matter what,so i was pointing to the perceived irony inherant in these death situations. also seeings i hadn't known of any proof of unconsious people having pain, i can only go on objective findings.because of some of these blogs, i now feel it is possible to have pain when unconscious, & will be giving pain meds,if not to error on the side of caution,possibly.sue

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