NEEDING Some HELP??

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Patient that had breast cancer, that had already spread to bone prior to her seeing the Dr., so surgeon did a simple mastectomy 4/09. Now she is on Hospice and having tremendous pain in her arm related to massive swelling. We have tried a light tubigrip compression the largest size F is to tight. Also have tried ace wrap but she didn't tolerate it and unwrap it. This is the only site she reports having pain is in her arm. Have tried a local lidocaine spray, with little luck. Any other ideas. We also have to be very careful because along her incision and all over her arm and uper chest she has skin mets. Please help :nurse:

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Specializes in Hospice, Palliative Care, OB/GYN, Peds,.

First of all I need to know what she is on for pain medication already. There are a multitude of pain meds, some specific for bone pain, nerve pain, etc. Sha may need a combination of meds. Have you tried Lidoderm patches to the are rather than the spray? Please write back and give us a list of meds.

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Duragesic 50mcg, lortab 10mg at HS (which she will not give up), Ibu 600mg BID, roxanol prn, cymbalta, and her daily b/p meds.

We did think about the lidoderm patch, but her oncologist warned us about the potential compliacations because of skin being so fragile, and potential issues if her skin breakdowns such as issues with flies/magets.. The family is aware of the possibility and does nto want anything on her skin except a spray this includes creams or lotions that would have to be rub in..

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Specializes in psych, addictions, hospice, education.

How often is she actually getting her roxanol? Why should she give up her bedtime lortab? Flies/maggots???? She's on hospice...this calls for intense intervention for pain. While the family has wishes, what are hers? Is she able to tell you and/or answer questions about it?

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She is taking Roxanol 2-3 times, it seems to happen more when she trying to do any ADLS. HHA visit daily, and her family assist her but there are still somethings she tries to do herself, simply putting on her shoes. Its the basic things she says she has always taken for granted. Only reason I mentioned Lortab is that is something she is not willing to change, she knows it works and we will continue with it. I am not for changing things that work. Prior to her hospice admission She did have 1 small open area along her incision, that had a very strong odor, that the oncologist was treating with aquacel ag covered with characol dressing. At this time there is no open areas or dressing. Wasn't sure if anyone had any other ideas regading her pain, or continue with the roxanol. Because her arm seems to be the only main complaint of pain at this time. Hip/rib pain resolved. Or ideas for her edema - the swelling seems to be more of a bother to the patient. thanks for listen and apprecaite any new ideas

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Specializes in psych, addictions, hospice, education.

Since Lortab works, why not use it during the day? How much Roxanol does she get at a time?

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

Has she been to a lymph edema clinic? They may be able to provide some helpful insight into managing that particular problem. It would be helpful if she were more cooperative with wraps...but perhaps a clinic visit could help in that regard as well...getting them on properly is part of the battle.

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