Long time lurker here. I have a question for all you nurses our there. I have a PT in pain crisis and is on a dilaudid pump. She is allergic to morphine in all forms. The problem is I have never had anyone on 42mg/hr and still be lucid and in pain. She is getting Ativan and Valium. Do any of you have any suggestions for controlling her pain. We are all stumped at my office and are pretty sure that she is not metabolizing the drugs. The needle was changed today and the pump is working properly. We even had the pharmacy send out a new bag to be sure that, that was not the problem. Any ideas???
We use methadone as well. Also, does she have any renal failure? With renal failure the Duragesic does work best for pain control. I generally don't like Duragesic d/t poor absorption but have found it to be beneficial at times.
Well happy/sad news. We finally got all of her symptoms controlled last night and 4 hours later she passed away peacefully. Thanks for all the suggestions. I will keep them in mind esp. the methadone for the next patient that comes along with the same problems.
Well, the good news is that she died without pain, in peace. And really, I no longer always find death sad. I used to be terrified of it, but now see it as a release from pain and suffering. And when an old person I love dies in their sleep I am glad that they were spared the terrible decline of surviving that horrible CVA or MI.
And you learned a lot from her, and will use that to help the next life entrusted to your care.
Specializes in Hospice, Palliative Care, Gero, dementia.
Glad it was finally controlled and she died comfortably. Good on you for trying all you could to get her there.
Find out how much experience your agencies medical director has with methadone. You really need to do close monitoring at first and have a plan (as in which of the several approaches to switching/titration you're going to use).
Specializes in ICU,HOME HEALTH, HOSPICE, HEALTH ED.
I have seen a fair dose of Decadron 4mg 3 x daily make a huge difference with uncontrolled nausea and pain. Just be prepared to increased the haldol to bigger doses too if it triggers more anxiety/insomnia--if she trusts the Dilaudid I'd leave it for now and watch to wean down as the Decadron kicks in. What about a neuropathic at bedtime if haldol doesn't work. She is needing significant nervous system soothing. Any chance of mets to the brain? Good luck-these always hurt our heart until we ease the pain. What about Good MSW or chaplain support? She sounds like her time is quite short.
Specializes in HOSPICE,MED-SURG, ONCOLOGY,ORTHOPAEDICS.
One of the worst things for a hospice nurse is a symptom crisis. Remember, the right dose of the opioid is the dose that controlls the pain. I once had a very young Ovarian CA (27 yo)patient that was on 90mg of Dilaudid/hour with a rescue does of 25mg Q15 minutes--and she was up walking to her neighbors house and to the store! After doing this quite some time, one of the things that I have seen work well for uncontrolled pain is Versed or Ketamin on a pump with the dilaudid--My little patient was not only on the above dose of Dilaudid, but on 14mg of Versed an hour prior to her death (Yes, these are the correct numbers). What is important is that she died very peacefully (when she was ready) with her family at her bedside. Remember to rotate you opioids so you don't get the nasty side effects. Pharmacy doses our versed, but I think the usual starting dose is 0.5 to 1mg bolus and 0.2-0.5mg hour to strart with titration.
NurseAlwaysNForever
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We use methadone as well. Also, does she have any renal failure? With renal failure the Duragesic does work best for pain control. I generally don't like Duragesic d/t poor absorption but have found it to be beneficial at times.