Query re Palliative Medication

jemb · Oct 14, 2003

So sorry to hear about your father's illness. How wonderful that he has such a caring offspring.

But without seeing him and having access to his history, current labs etc., it would be inappropriate for an RN on any BB to guess whether he is being overmedicated. My only comment on this aspect of your post is that I have had many patients who have recieved much higher doses to relieve or prevent symptoms.

Confusion can be part of the disease process. It could be related to electrolyte imbalances, hypoxia, metastasis, to name a few possibilities.

How recently has a hospice nurse or MD seen your father? If you are seeing significant changes in his behavior or mental status, you need to contact the hospice or doctor's office.

I would suggest that you call them to espress your concerns and ask questions about your father's specific meds .

aimeee, BSN, RN · Oct 15, 2003

Jemb said it all beautifully. You need to express your concerns to the medical team for your father. They should be happy to explain the rationale for the regimen and explain how each applies to your father's particular situation.

niamh · Oct 15, 2003

Hi jemb & aimeee, thanks for taking the trouble to reply.

I have discussed side effects with nurse & dr.

Nurse comes every day to fill the s/driver. She said she had never come across side effects with buscopan, but it has many possible side effects, so I suspect she cannot distinguish between results of illness & side effects of drugs.

Dr. has twice expressed concerns that Dad is overmedicated & has reduced drugs. He is not very experienced in palliative care.

I think they started off the s/driver with too many drugs. When he was taking meds orally, he was on morphine & haloperidol only, but even these were started arbitrarily. e.g. they prescribed morphine even though he has never complained of pain. When they put him on the s/driver they added two more drugs.

We cannot really risk reducing meds further if he is not able to say how he feels.

Thanks again for your help.

STM · Nov 6, 2003

Originally posted by niamh
Hi jemb & aimeee, thanks for taking the trouble to reply.

I have discussed side effects with nurse & dr.

Nurse comes every day to fill the s/driver. She said she had never come across side effects with buscopan, but it has many possible side effects, so I suspect she cannot distinguish between results of illness & side effects of drugs.

Dr. has twice expressed concerns that Dad is overmedicated & has reduced drugs. He is not very experienced in palliative care.

I think they started off the s/driver with too many drugs. When he was taking meds orally, he was on morphine & haloperidol only, but even these were started arbitrarily. e.g. they prescribed morphine even though he has never complained of pain. When they put him on the s/driver they added two more drugs.

We cannot really risk reducing meds further if he is not able to say how he feels.

Thanks again for your help.

I haven't seen a syringe driver in the US! We use Cadds, Abbott Aim's, Saberteck. I am back from my second trip to the UK to work in the St. Christopher's Hospice and with Dame Cicely Saunders. They have a super team, I don't recognize the names of some of the meds they use.

The morphine may be given to insure that he is comfortable. It is also given to aid in his breathing. If the doctor thinks he is overmedicated...is this an oncologist type doctor or regular practictioner. Big difference in pain management skills and knowledge, but the nurse working with your dad the most should be able to help you the most with your questions. Plus, when they first add or increase a med, he may seem over medicated but needs to adjust, and will do that rather quickly. Take care, glad your dad has you to watch out for him!!!!