Pammy

Thanks everyone for the ideas... unfortunately, like I said, my client is not absorbing well topically, and is too dehydrated to absorb any more rectally; can't swallow PO, too dehydrated for IV (wouldn't last). I do like the idea of the scopalamine, for future reference!! Actually, today we tried Lorazepam Intensol (2mg/ml), and it has so far had better (but not complete) results.. the client slept several hours, at last. I may even try scopalamine every 6-12 hours to see if it helps. I know one thing... when I get through this tough case, I may be known as the nausea and vomiting queen! Again, thanks all...

My client has Lung CA with mets, and has had increasing nausea and vomiting ... to the point that it is now almost hourly. He is bedbound, has had no PO intake for over two weeks with only very small sips of water on occasion. He also has moderate pain to his left side, beneath his ribs (his CA originated in left lung lobe). He is still having BMs, and voiding small amounts. MOVEMENT, or even visual movement, seems to increase the nausea. He is unable to swallow PO meds, and his perfusion is too poor to absorb topical gels... now, due to his dehydrated status, he is also beginning to be unable to absorb meds rectally. He is a home patient, and his spouse is a nervous wreck.. she has difficulty handling the situation, and is not very capable of learning about meds. Continous Care is currently in the home (LVN for 12 hour shift, CNA for 12 hour shift). Currently using the following meds: MSSR 50mg PR, Haldol 30mg PR, Dexamethasone 40mg loading dose, then 8mg PR (previously used prednisone, then switched to dex), Ketamine 2.5mg TOP, Phenergan 50mg PR AND TOP, Zofran 8mg dissolvable oral tabs (this med is actually the med that is most effective for longer relief). Actually, when we did the Dex loading dose of 40mg PR, it held off the N&V for about 8 hours; whether it was the dose itself, or whether it was the fact that he rectally absorbed SOME of the dose, is not known. I considered meclizine, due to the movement thing, but what route?????? I have run out of ideas, and would love to hear other suggestions. There is a long list of meds that have been tried, and dc'd. I am stumped!!

I agree with aimeee that you need to spend more time working on your skills, before you try hospice. In this profession, you are kind of out there on your own; and these people look to you for everything! Hospice patients are not all terminal cancer patients, either. You have COPDers, Dementia, and a variety of other terminal illnesses in hospice. Most Hospices require a variety of experiance before they will hire you. Keep in mind that you will be dealing with more than a client's illness.... they each have emotional, religious, and family issues that you will be involved in resolving. And often, the family issues are extreme. Be prepared for fist fights, attempts at suicide, anger directed at you because there is no one else. Hospice, to me, is a challenge; and it is wonderfully rewarding. Difficulties aside, I knew I belonged in Hospice years before I started doing this type of nursing. Do check with some of your local hospices, as aimeee suggested. Perhaps if you signed up for rotations through the different areas in your hospital, you could widen your experiance.