Kissy1818

We have been told that you don't need to wake a patient up, you can write on asleep, obviously can visually see sweating etc, but if they are asleep unlikely to need any meds at that time. Obviously still need to monitor vitals to check not over sedated

This is an old post but I have found what you wrote hits home and has helped me a lot, we can all make errors and be involved in errors and it's the worst feeling ever. I just wish I knew how to forgive myself.

I was just really looking for advice and experience, is aware the onset is fast and they peak fast and aware of half life's it was more that I am quite new to nursing and wanted ore experienced nurses to give me their opinions and knowledge. I completely agree we should not be expected to work outside our sphere of knowledge and I will always try and ask when I don't know something but when you don't work with nurses who will support and hate to be bothered it can be hard.

Thankyou. Would the outcome be resp arrest and cardiac arrest if undiagnosed? How fast would that occur?

Yeah I understand that not all palliative patients are end of life, therefore wouldn't be treated the same. As we get such a variety of patients copd ling cancer and chest infection's was more wondering if acidosis chnaged vital signs or caused any changes in actions of patients that may trigger me to aak for an abg. I think it is so important to be aqare of goal of care. Being new its so much to take in just trying to get all the tasks done with such little staff.

I think in hindsight I would agree.

Thankyou for all you advice has helped alot. I think I started tqi questions here. I work on a respiratory ward so get both palliative and non and uae opiates in both but tend to only use the benzos in palliative (only seen it given iv few times) both can cause resp depression abd together I presume that will increase. Juat wondered if there were other signs than resp and o2 sats should look for and should I worry about acidosis after their breathing is back to normal?

Also what would you do in the case of palliative patients who's resps decrease as it does seem naloxone or the reverse of benzoa isn't used? Would we skip next doses

Yeah we don't use to high doses like 5mg oxynorm or morphine 10mg is what I've seen. We give the narcotics to palliative and non palliative only seen benzos like midazolam given in palliative care. We had a patient where after about an hour of reduced resps but sats maintained on nrb mask he came round resps normal ahaould I be looking for signs of respiratory failure or acidosis? As an initial assessment would pulse and bp change? Thanks this infor has helped alot

On the area I work we use a lot of iv meds and especially opiates and sometimes bentos for palliative patients. I am aware that given these can both cause respiratory depression, how fast will this occur after iv admin? What would happen if its not noticed? Once the meds half life has been reached and patient is talking does that mean they are not at risk anymore? What else should I be aware, I'm scared I might miss something? If they aren't given O2 or naloxone fast will they deteriorate quickly?

In this occasion that distressed me the most the gentleman wasquite young, deteriorated quickly each time the midazolam wore off he was quite agitated trying to get out of bed, was this due to his illness or the meds? Maybe I will never know

I think its that I fear the patient may miss out on last words with family but I suppose if they are agitated it is much more destressing. And benzos have the same risks as opiates of respiratory depression. I think its Being new to this area of nursing.

I work in the uk and as a protocol for end of life agitation they uae midazolam prn and in syringe driver. Seems everywhere has different protocols. Just getting ny head round thw whole end of life thing, find it difficult sedating patients even when agitated as I wonder what affect it has on them and their family.

The gentleman died unfortunately. However he seemed comfortable had all his family around him I found the whole experience a bit distressing as I have so many questions but feel I have learned aome valuable lessons. Its a very hard situation to get your head round as I know the doctors decided this gentleman was palliative and end of life i just don't think I have quite got my head round the whole palliative care thing yet.

Just a little query so do we tend to only use midazolam in the last few days of life for palliative patients? Why is this and also why do we tend to uusethe sc route rather than iv? Thanks in advance