captain morgan

To all of you hospice pain gurus: I have a pt that has been taking Lortab 6xday with MS Contin (100mg) bid and Roxanol (20mg:1ml) 1ml q1-3 hrs prn breakthrough pain, and Fiorcet prn for headache (he takes at least 3 per day). Every time I ask him what his pain is - it's always at least a 7 and usually 10+ (Dx: lung CA). Meanwhile, he is conversing with me and his spouse without any apparent distress, joking around and such. Spoke with his MD and his meds got changed to Methadone, Decadron and Roxanol for breakthrough. He lasted 2 days and requested to be switched back to the Lortab regimen. He had a change of mental status (per spouse), and broke out in blotches - although he did not complain of a rash or itch. I'm just astonished that the methadone did not work - I've heard such good things about it. It makes me wonder whether this pt just loves his Lortab??? What do you think???

Thanks to all for your responses. I have had extensive experience in dialysis lifesite ports with locking needle and was wondering why the hook on the huber? It does not seem to be too stable. The pharmaceutical company supplied an inservice today, so that was helpful, as well as all of your suggestions, esp websites to check out. Thanks again - it was very appreciated. If I can help any of you out with dialysis questions, let me know!!!!

Hello, I'm actually a new hospice nurse, but am getting alot of patients with implanted portacaths for pain management. I'm unfamiliar with the care of these portacaths and am a little uneasy about changing the huber needles. They have a little hook on them, and I would appreciate any help you experienced oncology nurses could provide (a visual aid would be most helpful). Thanks for the help!:uhoh21:

I ordered and received the Symptom Management Algorithm book from Barnes & Noble and it is just great. I like that it's small and you can flip to what you need to know in a hurry. By the way, the above mentioned pt - after getting to the ER - got shipped off to a major med center - got intubated ( against his wishes on DNR!!!) and died 2 days later. The family relayed to us (hospice) that he died "an excrucitating death". If I can make it through orientation - maybe I'll do OK>>>>>

This is an extension of my previous thread. Again, thank you to all who took the time to reply. Well..........another day, another learning experience. The same pt called to get sent to the ER as he was in constant pain and could not breathe. When I got to the pts house, he was visably trying to breathe, diaphoretic and panicky. He refused any interventions ( increase Lasix, nebulizer, increase morphine, etc.), and insisted on me calling 911. I had to have him sign a revocation - and I have to tell you that I felt that I had failed this man. I admit that I am inexperienced in hospice/home health and wonder if a more experienced nurse would of handled it differently. The pt's sister (a retired nurse) was in tears, and she felt that he did not want to die in front of her in her house. Anyway, I went home feeling like sh....... and wondering if perhaps I made a mistake crossing over into hospice. The receptionist told me later, via my cell, that the marketing person wanted her to make sure I did everything I could to get him to stay with hospice. Right about now, I feel like applying for a job in Walmart - no kidding...

Thanks for all of your responses - Tomorrow is a new day and I can only pray that it will go better than Friday went. I am planning on having a very serious conversation with "corporate" and let them know how I feel about being thrown into something I have not been adequately trained in. That being said, does anyone know how to access a chemo port for IV morphine (how often do you change the needle and dressing???). I have never even seen the procedure in the "clinical procedures" manual in the office. So, again I go to the experts - YOU. Thanks and God Bless.

I am in week 2 of orientation in hospice and wanted some feedback on a situation that happened today. I was the only nurse in today with an admission on a Friday afternoon of a holiday weekend (need I go on???) I have not been oriented on an admission, or the CAAD pump that the pt required for continuous pain relief via a chemo port. (are we having fun yet???) I stumbled my way through the above in a little over 3 hours and left the pt's home wondering what the he.... I got myself in to. The pt is very sick with lung ca and multiple comorbidities. Also, the PCP was on his way to sunny Florida for the weekend. The only other RN that I could ask questions of was over 3 hours away and there was no cell reception where I was at. I feel I did the pt and his family a disservice by just "making due" and "getting it done". Any advice for a week 2 orientation newbee? Thanks.

Thanks all you hospice guru's....I did up the morphine and he is doing much better. He has even been able to putt around in his garden a bit on good days. And I will be investing in a good symptom mgt book.... thanks again and God bless.

I have started a new job as a hospice nurse and need help on symptom management. Esp. pain. I have a pt who has dx: lung CA who is rating his pain 10+, yet he is sitting up and talking with me???? He is on quite a lot of pain meds - morphine, AHBV suppositories, haldol, xanax. What am I going to do when he gets worse??? I feel like I'm not doing much for him when I check in on him, so I was wondering if anyone has any advice for an old nurse starting a new avenue of nursing?? Thanks so much.

Thank you to all who answered. You all sound pretty happy overall with hospice nursing and I am excited about starting next week. I'm sure you'll be hearing alot from me in the coming months as I learn the ropes.... Again, thanks for your input.

Hello - I am crossing over (no pun intended) into the hospice field from dialysis and was wondering if anyone can give me their perspective on hospice nursing. The likes/dislikes, etc. I have done acute dialysis as well as chronic for the last 7 years and the acute on call was horrendous. I wonder if the hospice on call will be as well. I needed a break from dialysis as it is very physically and mentally demanding, and I'm hoping that hospice will be a good fit. I start next week. Any info would be appreciated. Also, what are hospice nurses getting paid. I live in TN. Thanks so much.....