ordered to give roxanol with resp. of 5

[wantsthebest]

I was recently ordered to give a dose of Roxanol to a patient with terminal Alzheimers. I withheld the dose due to the fact that his resp. was 5, there were no s/s of pain, no SOB, and no labored breathing. Pulse was slow and weak. No response from stimuli. The MD said I should give it and (I quote) "you can make it a humane death"

I have a problem with this, I always thought that we first do no harm, isnt giving some one something they dont need harm? No signs of distress, just someone busy dying and not having a problem with it.

[leslie :-D]

if your pt has been asymptomatic, then there is no logical rationale for giving the roxanol with a rr of 5.

i have given morphine often, without parameters.

but these pts had experienced intractible symptoms and required an ongoing amt in order to relieve their distress.

but i will not randomly continue in dispensing this stuff in the absence of pain/dyspnea.

you do have a right to refuse.

leslie

[Focker, CRNA]

Did the family request it? If the family feels like the pt. is in pain, or if there is any doubt about the comfort of the patient, I don't see how any harm could result from making your best effort to make the pt. comfortable as they die. I probably would have given it.

[leslie :-D]

families often request increase, more frequent dosaging in the presence of anxiety.

furthermore, the process of dying itself, is a relatively humane and comfortable process.

it is when specific disease/trauma processes interfere and so, containing symptoms becomes the focus.

in the absence of these symptoms, continuing to administer morphine could be construed as a form of euthanasia.

as long as there are experienced staff deeming the pt w/no duress, then continuing to give a potent narcotic for the sake of the family, would and should be contraindicated.

leslie

[wantsthebest]

Did the family request it? If the family feels like the pt. is in pain, or if there is any doubt about the comfort of the patient, I don't see how any harm could result from making your best effort to make the pt. comfortable as they die. I probably would have given it.

the patient in question has end stage alzheimers, his wife stopped letting us take him to the dining room, insisted on trays in his room, said she would feed him. he began losing weight. under orders, we began to feed him after she left, his weight stabalized. she then got an order to make him NPO and ate and drank in front of him. after 10 days she got the order for Roxanol, Q2, routine at family request.

When I questioned the DON, I was told not to give it with a rr of 5. the hospice supervisor said not to give it either when they were called. our medical director agrees, as does the hospice medical director.

it has been 14 days since any food or hydration and my facility stands by the decision of not giving the drug with no s/s of pain, dyspnea ect. and a rr below pramaters. he still lives.

[Focker, CRNA]

the patient in question has end stage alzheimers, his wife stopped letting us take him to the dining room, insisted on trays in his room, said she would feed him. he began losing weight. under orders, we began to feed him after she left, his weight stabalized. she then got an order to make him NPO and ate and drank in front of him. after 10 days she got the order for Roxanol, Q2, routine at family request.

When I questioned the DON, I was told not to give it with a rr of 5. the hospice supervisor said not to give it either when they were called. our medical director agrees, as does the hospice medical director.

it has been 14 days since any food or hydration and my facility stands by the decision of not giving the drug with no s/s of pain, dyspnea ect. and a rr below pramaters. he still lives.

Thanks for the extra info. With all the backup of supervisors, etc. it sounds like you were technically ok to withhold the drug. But I still agree with the doctor.

Personally, if I were that man, I would want the morphine given to me, in fact, in situations like this I fail to see why euthanasia would be inappropriate. I know it is technically illegal and some are morally opposed, but when you say "do no harm," do you think allowing a man to slowly die over many weeks is less harmful than giving him a pain medicine that may speed his death as a side effect, when death is inevitable with either option? I think it is fairly obvious that not feeding/hydrating him is itself euthanasia, the only difference is it is passive. I would rather be active and be SURE that he was painfree rather than hoping that inside there somewhere he wasn't aware of his situation.

[Athenas83]

it has been 14 days since any food or hydration and my facility stands by the decision of not giving the drug with no s/s of pain, dyspnea ect. and a rr below pramaters. he still lives.

14 days? Oh my, poor guy

[RNCRNA2BE]

Thanks for the extra info. With all the backup of supervisors, etc. it sounds like you were technically ok to withhold the drug. But I still agree with the doctor.

Personally, if I were that man, I would want the morphine given to me, in fact, in situations like this I fail to see why euthanasia would be inappropriate. I know it is technically illegal and some are morally opposed, but when you say "do no harm," do you think allowing a man to slowly die over many weeks is less harmful than giving him a pain medicine that may speed his death as a side effect, when death is inevitable with either option? I think it is fairly obvious that not feeding/hydrating him is itself euthanasia, the only difference is it is passive. I would rather be active and be SURE that he was painfree rather than hoping that inside there somewhere he wasn't aware of his situation.

I agree. The man is dying. Give him the pain med.

[slinkeecat]

It is crap like this that makes me want to tattoo my advanced directives on my chest w/ capital letters of giving me pain meds around the clock even if I am not screaming, I want it to be assumed that I am in pain....I promise you, I won't get addicted and if I am terminal, and going to die anyway then give me the freakin' pain med. I swear I will come back somehow and haunt the nurse who doen't manage my pain....gee whiz!!

[leslie :-D]

It is crap like this that makes me want to tattoo my advanced directives on my chest w/ capital letters of giving me pain meds around the clock even if I am not screaming, I want it to be assumed that I am in pain....I promise you, I won't get addicted and if I am terminal, and going to die anyway then give me the freakin' pain med. I swear I will come back somehow and haunt the nurse who doen't manage my pain....gee whiz!!

this particular pt has not been dx'd w/any respiratory compromise.

he has end-stage alzheimer's.

and so, with a rr of 5/min, i think it's very safe to say that the morphine has taken its' effect.

there is nothing in the op's post that would indicate that his pain isn't being properly managed.

leslie

[NurseStace]

his wife stopped letting us take him to the dining room, insisted on trays in his room, said she would feed him. he began losing weight. under orders, we began to feed him after she left, his weight stabalized. she then got an order to make him NPO and ate and drank in front of him. after 10 days she got the order for Roxanol, Q2, routine at family request.

My question here is... was he able to eat, and she didnt want him fed? I would have a serious problem with someone who ate with assist, and his wife getting orders to make him NPO. Is she trying to starve this poor man to speed up the dying process?

Stacy

[medsurgnurse, RN]

It is crap like this that makes me want to tattoo my advanced directives on my chest w/ capital letters of giving me pain meds around the clock even if I am not screaming, I want it to be assumed that I am in pain....I promise you, I won't get addicted and if I am terminal, and going to die anyway then give me the freakin' pain med. I swear I will come back somehow and haunt the nurse who doen't manage my pain....gee whiz!!

Go back and read the original post again.