My poor resident

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Specializes in Cardiac/Step-Down, MedSurg, LTC.

I have a resident in my nursing home who is 102 years old. She has been through the ringer the past year that I've been working here, but she has always pulled through (example: two falls in one day).

She's been fairly sick lately with pneumonia, and even got sent out to the hospital last Friday for an evaluation. She's been yelling out all day and night, obviously in some kind of pain, but she cannot localize where it is (appears to be abdominal). Yesterday and this morning she has coughed up frank blood clots. Normally this would be the type of situation where I'd call up the covering and ask for some advice (and probably end up sending her out to the ER again), but as of two days ago she is now a Do Not Hospitalize on top of her DNR. I really do not know what to do for her anymore. She is on PRN roxanol 2mg q 2 hours, but it's a hassle to even try to get this small amount of liquid into her mouth. She's beginning to fight away staff, won't eat or drink, and barely gets meds down.

I know she is probably going to die soon, but I hate to see this woman in that kind of pain and feeling helpless toward making her comfortable.

Thanks for listening, this poor lady is just making me too sad. :redbeathe

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Specializes in Med/Surge, Private Duty Peds.

so sorry to hear this, have you tried getting the md to try another alternative way for pain meds, maybe rectal?

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Specializes in Maternal - Child Health.

Bless you for looking out for this precious soul.

Please do your best to keep her medicated for pain. I'm no hospice expert, but perhaps there are other options that would be easier to administer?

Would it be possible to have someone sit with her. She must be fearful and this might comfort her. Soft music? Aromatherapy? A soft, warm blanket? A nuzzle from a friendly dog?

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Specializes in Oncology.

Topical morphine would be a good option.

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Specializes in Cardiac/Step-Down, MedSurg, LTC.

Thank you very much for listening, Jolie and nurse hobbit. The alternative route method could possibly work. She did have a Fentanyl patch Rx, but it did not seem to provide much relief. The rectal idea might work, if my CNAs could help me hold her calmly while inserting it.

Unfortunately in my facility we don't have enough staff to provide a 1:1 unless someone like the SDC or an activities person would take some time out. Even the few minutes I spent with her seemed to work her up more. I would try the music option, but she is HOH.

One thing I do wish is that we had a house cat. Apparently there was one years ago, Morris, who would hang out around the Nurses' station. With allergies that residents have nowadays and infection control, I doubt we'd ever get a cat like Morris back ...

I just hope that she can find some sleep and go to "Henry" (her husband) that she was yelling out for last night.

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Specializes in ER.

More Fentanyl, double the dose, at least, and rectal Valium so this poor soul can get some peace.

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Specializes in psych, addictions, hospice, education.

You can't get the roxanol dropper through her lips into her cheek area? This seems much less distressing than an rectal medication to me.

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Poor old thing. And thank you for caring.

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Specializes in School Nursing.

god bless you for caring about this elderly lady. sounds like she's ready to go.

praiser :heartbeat

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Specializes in Cardiac/Step-Down, MedSurg, LTC.

To answer Whispera, every time I get close enough to drop in the roxanol she begins so scream, shake her head and flail her arms and try to grab the dropper. I don't know if she realizes it's pain medicine, even though I tried numerous times to explain it to her. I think she is just completely out of it now.

Blondy2061h: I think the topical morphine would be a great idea. Is it a similar gel like an ABHR? I will have to see if it's available through our Pharmacy.

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Specializes in school nursing, ortho, trauma.

something topical is the way to go either in a morphine or a stronger fentanyl patch or anything at this point.

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Specializes in Telemetry & Obs.

Bless her heart! If she won't accept PO meds, I doubt she'd want PR either. Patches?? That's all I can think of....I'm sure IV is out of the question?

I hope she sees Henry soon :(

And bless YOU for caring so much!

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