RN Case Mngr Hospice

[RNDYN2CU]

I am looking for feedback from other RN's, I've been in Hospice 8 months, LOVE it, got questions, I'll put em' out there, who knows, maybe I'll get some feedback!

Here's my glitch: got a pt. on dilaudid via PCA/CADD in a longterm SNF, came in with a PIC line, Pain outa control (poor woman, ca of spine:o). PIC failed, tried SQ, no go, (Still moaning...) started regular IV. I want to find a Policy and procedure to submit that allows us to administer IV pain med for our Patients that NEED it.

QUESTION. does anybody know if there is a policy and procedure out there that allows an LVN to at leaste press the pre calibrated "dose" button on a dying patient's PCA to a regular IV line, in a SNF, this woman's pain is off the charts and an RN is not always on shift... ANYONE????? THx

Nurse Leslie

[RNDYN2CU]

first i heard of methadone for pain mngmt.... do tell, info please. Thx

Leslie

[doodlemom]

Methadone works on all of the receptor sites (Mu, delta, kappa, and NMDA.) It is the only narcotic that works on the delta receptor which provides analgesia only. The NMDA receptor works on neuropathic pain and we end up using less drugs like elavil and neurontin. We like to use it because it works better than any other narcotic AND it is dirt cheap. It is naturally long acting - so we usually use something else for breakthrough pain. It comes in a high concentration liquid for sl use. The kicker is that it is not that easy to does unless you know what you are doing. We are fortunate that we have a medical director that knows it well and helps us a great deal with dosing.

[RNDYN2CU]

DOODLEMOM is smart

[doodlemom]

DOODLEMOM is smart

Ha! I'm glad someone thinks so!

[mom4josh]

We often use Duragesic patches for long term relief, especially if pt cannot swallow or has no IV site. Just an idea.

[lesrn2005]

Methadone works on all of the receptor sites (Mu, delta, kappa, and NMDA.) It is the only narcotic that works on the delta receptor which provides analgesia only. The NMDA receptor works on neuropathic pain and we end up using less drugs like elavil and neurontin. We like to use it because it works better than any other narcotic AND it is dirt cheap. It is naturally long acting - so we usually use something else for breakthrough pain. It comes in a high concentration liquid for sl use. The kicker is that it is not that easy to does unless you know what you are doing. We are fortunate that we have a medical director that knows it well and helps us a great deal with dosing.

Hey doodle: spell out the Mu and NMDA receptors please-thanks!!

[sharona97, BSN, RN]

Dumb question: Why is this pt with CA of spine suggested to use prednisone? Just curious. I am not a hospice nurse, but am very interested in becoming one. Thanks for any reply.

Sheri

[doodlemom]

Hey doodle: spell out the Mu and NMDA receptors please-thanks!!

I don't remember if mu stands for anything - just that there are 3 categories of mu receptors.

NMDA = N-methyl d-aspartate

I'm sure if you google it, you will find a lot more info than I can give you.

[doodlemom]

Dumb question: Why is this pt with CA of spine suggested to use prednisone? Just curious. I am not a hospice nurse, but am very interested in becoming one. Thanks for any reply.

Sheri

We frequently give steroids for bone mets - it helps with inflammation and pain. We usually use decadron.

[coralynwoodson]

I am a Patient Care Coordinator with a start up hospice. The work is plenty. My day, like many of yours starts early. Usually when I start, I will have mapped out my plan of care for the patient who I'm going to see. I copy the last note to compare for changes. I have to ensure that the POC is working or if I need to consider changes, relay changes to the MDs, I talk to my manager all day it seems to make sure that everything is okay. Most of all my fellow nurses, this is a thankless job but I still love it. I have run into some ungrateful families of patients who really need us. The patients were good to work with, but the families, who have to endure stress are sometimes not so mellow. Still I love what I do. I encourage you, stay with hospice, it takes a special gifted nurse to stay. We will probably count more hard days that smooth ones, but I believe we will be rewarded for the work we do.

[hospicemom]

i agree with the palliative sedation. maybe inpatient for a block?

[Bonnieclydeduo]

I'm not a Hospice nurse yet, but I have been taking courses online to learn more about it. For your pt with intractable pain: She could be admitted to an acute care setting for pain control and, if necessary, be totally sedated. It's something I have only read about-I have no first hand experience-but your pt sounds like she needs something like that.