Libralady

Thank you Ginger! You are most kind. I love Hospice Nursing but I still have much to learn.

Thanks so much! Before I left, my patient's face changed dramaticly. Before, there were some grimmaces and furrowing of the brow which decreased when I dosed him. But 1 1/2 hours before I left, his face became very relaxed. Believe it or not, though he was very, very pale, he began to appear 10 years younger. It was as if he accepted things and was ready for his journey. I brought in the family and explained it to them and they saw it. They were comforted by this very calm appearence. He passed at 3:30 the next morning. Thank you all for your kindness. I believe I have found a new home with other nurses. I am thrilled that I found this site! Cheers ~:studyowl:

Ginger, I was in a private home. In my previous Hospice job, we almost never used IV meds, only sublingual, patches or suppositories. This is a new Hospice job and some of the other nurses are saying that this hospice job is starting to use CADD pumps more and more. My day nurse also gave around 12 - 15 doses, then the Hospice doctor came around 2:00 p.m. and increased the basal dose at that time. I had hoped that it was sufficent. I want to increase my learning curve on using the CADD pumps since I am somewhat distressed at myself over last night. I want to ask my superiors for more learning opportunities without jepordizing my job. As much as I love Hospice nursing from my previous job, I will need to make changes to adapt to this new position and hope that they will understand and help me to learn their protocals without it appearing that I am not up for the job. There weren't any protocals discussed in orientation so I am "learning on the job". I hope to find the resources that I need. But then, I found this site and I am delighted. I would welcome any leads and advice. I want to become the very best Hospice nurse that I can be. Thanks so much!

Thank you. My patient was totally unresponsive so I was dosing him. Is there a good source for protocals for dosing medications in these instances? Most certainly, if he was responsive and not kept comfortable, I would have called. But I was able to keep him comfortable. They had already up the dosage that afternoon but I want to become more proficient in good dosing protocals.

Greetings, I have a question about the concentration and prn dosage of a medication. At work tonight, I have a Hospice patient who was on Diladud 5 mg/hr via CADD pump with breakthrough pain boluses of 1.5 mg. every 10 minutes prn for pain. My patient needed quite a few doses on the first half of the shift but as he progressed, I didn't have to dose him as much. For the 4- 12 shift, I had to give him 15 doses. The night nurse who came after me said that I gave him too many prn doses and that I should have called Triage for an order to increase the regular dose. But I kept him comfortable with the prn dosing. Should I have called to increase the regular dose or was I able to keep him as comfortable as I believed I did? He is actively dying and by 10:30, he appeared to be calm, comfortable & relaxed except for repositioning, for which I gave him the prn dose. He has Ativan 1 mg Q 4 hours and 1 mg.,Q 4 hours prn for anxiety. I only had to give him 1 prn dose. I would like to learn more about those nuances of med dosages. Thanks!