CoastMedRN

Unnecessary comment CalArmy.

Why is there a need to be sarcastic or a smart___ to my post? Can never understand why

Thank you ALL for taking time to read and comment. However, I am well aware as all of you are about the disease process, dosages, the effects etc. Also, that hospice is end if life and meds comfort but at the same time can hasten death unknowingly. My question however is if you have ever had a family ask if THAT dose resulted in the patients death ... or even if you have asked yourself that question? I am not in any manner suggesting the dose was too high or anything related. Just the situation where the patient expired soon after the dose. Not even suggesting the dose hastened death. Assuming it was just that time dose or no dose. Of course families are anticipating death. Even welcoming it. Just the PERHAPS awkward timing. Of course we give our regrets. We comfort. But wondering simply if a family member has ever asked ... and your response ... if the question asked was: "Do you think the medication was why they died at this moment"? NOT an accusation, not that the nurse did anything wrong. Merely have you ever had this situation take place. BTW I am an RN with decades experience in Critical Care etc and Hospice so not a "homework" question lol. Thanks again to you all.

Have you ever had a TERMINAL care patient or hospice patient who has been getting regular doses of (either separate or in combo) morphine, dilaudid and morphine for pain/respiratory distress/anxiety and just after you give a dose/doses on your rounds the patient passes? If the family is present have they ever made any comments or have you felt obligated to make a comment? I am not suggesting the dose WAS the cause of their passing at that time and the nurse did anything wrong AND for purpose of my question the patient was comatose for a few days, expected to pass, was receiving the same doses from other nurses so no suggestion YOUR administration hastened or sped up the death. Just wondering how you dealt with it because it might be awkward in some cases.

Huh? Explain the relationship with acid reflux? Never heard that but glad to hear your views. The only rationale I have ever heard is the threat of emesis or aspiration but again want to stress if this makes sense for the few cc's that come out of a tube in 5 minutes more or less. Don't want to stifle your thoughts however as maybe you have the answer...thanks.

I know we have been taught to STOP/HOLD a tube feeding whenever we place the patient flat for short term procedures like baths, turning, etc. But I want opinions if this ritual makes sense and why. For example, to place a patient flat for pulling up in bed, say 5 minutes for a fresh pad etc. why stop the tube feeding since the patient will be getting maybe 5 cc of feeding more or less. I understand it is policy normally to DO this but what is your opinion of the science behind it? One GI doctor told me it really does not matter or make sense for a few minutes if the feeding is 75cc/hr or less. Another GI doctor said absolutely hold it but could only say "that is the policy" but could not explain how a few cc's for short term would lead to emesis or aspiration. Your thoughts pro/con/whatever. And if you have any case studies/science behind it not just "it's policy where I work". Thanks my colleagues for any thoughts.

are you still there? how is el paso? love to e mail you if possible.

Any idea what per diem rates are for RN's in El Paso for critical care? And staff rates for critical care if you have many years of experience? Thanks for any help. Am interested in Thomason or Providence or Sierra. Any ideas from anyone? Sure appreciate any help. Am relocating from Los Angeles next year. I am [email protected]