I have started a new job as a hospice nurse and need help on symptom management. Esp. pain. I have a pt who has dx: lung CA who is rating his pain 10+, yet he is sitting up and talking with me???? He is on quite a lot of pain meds - morphine, AHBV suppositories, haldol, xanax. What am I going to do when he gets worse??? I feel like I'm not doing much for him when I check in on him, so I was wondering if anyone has any advice for an old nurse starting a new avenue of nursing??Thanks so much.
river1951 98 Posts May 21, 2007 People who have pain can have high pain and still talk- some folks will always rate their pain as a 10. But we still must treat- I would use immediate release morphine elixir and have them give him enough to knock the pain back- get a range from the doc of 0.5 to 2 ml (10-40mg) orally every hour. Total the dose for a day, divide by 2, and voila you have your long acting morphine dose for every 12 hours. That is if he (she) has pain uncomplictated by bone pain or nerve pain- for those adjuvant meds are given in addition to the morphine- for bone pain you can give any anti inflammatory if tolerated (if patient is eating), and for nerve pain you can use valproic acid (Depakoate) or amitryptilline or neurontin.Get a good symptom mgt book.And realize that sometimes patients have unresolved psychological issues, till those are relieved sometimes nothing you can do will matter..And welcome, it's a great place to do good things!River
Hospice Nurse LPN, BSN, RN 1,472 Posts Specializes in LTC, Psych, Hospice. Has 15 years experience. May 22, 2007 Does your pt have history of alcohol or drug (legal or illegal) use? This is something I always ask.....not to judge, but because when folks have a history pain will be harder to manage. And don't forget "spiritual pain". I totally agree with river1951 about everything suggested.
aimeee, BSN, RN 932 Posts May 22, 2007 Does your pt have history of alcohol or drug (legal or illegal) use? This is something I always ask.....not to judge, but because when folks have a history pain will be harder to manage. And don't forget "spiritual pain". I totally agree with river1951 about everything suggested.People who have a history of drug or alcohol use often take much larger doses to achieve the same results. They may also manifest their "spiritual pain" in physical symptoms. It doesn't make it any less real to them, but it does make it more difficult to achieve comfort for them. Everybody has their favorite, but this little book packs a lot of good information into a fairly small size. Our medical director recommended it and I have found it to be a good resource for thinking through issues:Symptom Management Algorithms by Linda Wrede-Seaman
EmptytheBoat 96 Posts Specializes in Med-Surg, Rehab, MRDD, Home Health. Has 12 years experience. May 26, 2007 Don't wait until he gets worse, titrate medication until you get yourpatient comfortable; and let your total assessment determine his comfortlevel, use your education/experience.
captain morgan 11 Posts May 26, 2007 Thanks all you hospice guru's....I did up the morphine and he is doing much better. He has even been able to putt around in his garden a bit on good days. And I will be investing in a good symptom mgt book.... thanks again and God bless.
RNDYN2CU 52 Posts Specializes in ICU/CCU, Peds, DD's, Hospice. Has 16 years experience. May 27, 2007 I have started a new job as a hospice nurse and need help on symptom management. Esp. pain. I have a pt who has dx: lung CA who is rating his pain 10+, yet he is sitting up and talking with me???? He is on quite a lot of pain meds - morphine, AHBV suppositories, haldol, xanax. What am I going to do when he gets worse??? I feel like I'm not doing much for him when I check in on him, so I was wondering if anyone has any advice for an old nurse starting a new avenue of nursing??Thanks so much. Dilaudid via CADD pump for pain mngmt may work...
