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
The hospital I used to work at had a pain mgt/palliative med team. Sometimes they would write orders for SQ morphine. You might be able to place a SQ butterfly even if she wouldn't tolerate having an IV placed.
Agree w/ increase in the duragesic dose, and don't forget that it will take a day for the increase to be effective. Also agree w/ opsite over the patch, have done this often myself.
Well, another night, another worked up lady. She has scheduled roxanol now, which still didn't seem to touch her. They upped the dose to 3mg SL. They also ordered 0.5 of ativan prn, which didn't help either. She was still up all night, speaking in French, barely getting out coherent statements. At least tonight she was a bit more manageable in getting meds into her.
I wish I could have had more time to focus on her, but I had an orientee on with me, which I didn't expect. That really threw me... it's hard to focus on 30 residents when you're trying to explain every little thing to someone brand new to the floor
Thank you. She did get the okay for a hospice consult, and I believe it was Hospice's recommendation to schedule the Roxanol around the clock, ativan, and implement Levsin for secretions. These are ALWAYS the first steps hospice takes with the residents I've known. Who knows, maybe they'll throw in some ABHR gel too while they're at it (another common hospice med). I only wish they could have a 1:1 hospice aide for more than 1 hour a day. ..
As an fyi to everyone who wished both my resident and me peace, she passed away early Sunday morning. Unfortunately I wasn't working, and didn't find out until last night. She and Henry are together now, speaking French to one another.
catshowlady
393 Posts
The hospital I used to work at had a pain mgt/palliative med team. Sometimes they would write orders for SQ morphine. You might be able to place a SQ butterfly even if she wouldn't tolerate having an IV placed.
Agree w/ increase in the duragesic dose, and don't forget that it will take a day for the increase to be effective. Also agree w/ opsite over the patch, have done this often myself.
Hope this lady gets to reunite w/ her Henry soon.