need some advice on use of iv

[Kissy1818]

Hi I'm a new staff nurse and we recently had a patient with lubg cancer who the docs decided was dnar and as was agitated needed midazolam. This patient was given the midazolam 2.5 iv and some oxycodone iv 5 I think, not sure. He became sedated but his sats had dropped also they out him on 15litres of oxygen and his sats come up his rr were low about 10 but rest of ovs stable. He was sedated for about an hour then came round vut agitated still. Is this normal. We now are uaing sub cut route but should more have been done e.g sto reverse these meds thanks.

I wouldn't worry about it if his sats responded to the oxygen and if his other vs were normal.

RR = 10 isn't too dramatic.

I would put him on end tidal CO2, too. No need for naloxone or flumazanil.

DNR is irrelevant.

[toomuchbaloney]

Hi I'm a new staff nurse and we recently had a patient with lubg cancer who the docs decided was dnar and as was agitated needed midazolam. This patient was given the midazolam 2.5 iv and some oxycodone iv 5 I think, not sure. He became sedated but his sats had dropped also they out him on 15litres of oxygen and his sats come up his rr were low about 10 but rest of ovs stable. He was sedated for about an hour then came round vut agitated still. Is this normal. We now are uaing sub cut route but should more have been done e.g sto reverse these meds thanks.

I hope that the patient and family made the DNR decision and not the MDs.

Why not a referral to hospice?

What does the patient want in terms of palliation of symptoms?

ARe there brain mets which are exacerbating the neuro symptoms that the patient is experiencing?

[Kissy1818]

The main decisoon was made by docs and agreed with vy family. Not sure about brain mets he was end of life. Was awaiting a hospice bex but there aren't many in the area.

[Kissy1818]

Thanks that was reallt good advice

[Kissy1818]

The gentleman died unfortunately. However he seemed comfortable had all his family around him

I found the whole experience a bit distressing as I have so many questions but feel I have learned aome valuable lessons. Its a very hard situation to get your head round as I know the doctors decided this gentleman was palliative and end of life i just don't think I have quite got my head round the whole palliative care thing yet.

[KelRN215, BSN, RN]

The gentleman died unfortunately. However he seemed comfortable had all his family around him

I found the whole experience a bit distressing as I have so many questions but feel I have learned aome valuable lessons. Its a very hard situation to get your head round as I know the doctors decided this gentleman was palliative and end of life i just don't think I have quite got my head round the whole palliative care thing yet.

Palliative care is the kindest option for end stage cancer. I've seen it both ways- people who choose the palliative care route and people who go for a phase I trial and die horrible deaths. There is no saving someone with end stage lung cancer. The longer you work with oncology patients the easier it will be to wrap your head around it.