Terminal Agitation

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Specializes in Gerontology, Med surg, Home Health.

I have a patient...lung cancer...on hospice. She is dreadfully agitated. Won't sit still,won't keep her clothes on, can't eat. We have tried: Roxinal, Ativan, Thorazine, Compazine, ABHR suppositories, tylenol, massage, music, everything we can think of and still we can't help this poor woman.

Any ideas???

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how bout haldol?

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Maybe she's reacting to a drug she's already taking? Sometimes a drug that isn't supossed to agitate, agitates a few anyways.

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Yes, I Was Thinking It May Also Be A Reaction To The Medications. But, If She Is Having Them Before During And After Tx, You May Want To Try Elavil....this Anti-depressant Can Also Help With Pain, And Therefore May Calm Her.

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Specializes in Gerontology, Med surg, Home Health.

The ABHR contains Ativan, Benadryl, Haldol, and Reglan. We've tapered off the morphine thinking it might be adding to her anxiety. I'm thinking we should stop everything since nothing seems to be working and try Valium...oh yeah...we've also tried Ambien.

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i'm really surprised about the morphine adding to her anxiety.....

i've heard of paradoxical reactions but typically morphine works like a gem, if given in sufficient dosages.

haldol is another one that works well, combined with the morphine; or sometimes seroquel is used.

it soundsl like her agitiation is from hypoxia or hypercapnea.

has anyone considered fentanyl?

i know personally with my mother, they experimented with many different combinations but ultimately it was the morphine that worked, once i told them she needed a much higher dosage than she was receiving.

and when she died, she had bil pneumonia with one lung being totally collapsed.

but once they started that morphine drip, it worked beautifully.

leslie

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Specializes in Gerontology, Med surg, Home Health.

Her 02 sats have been in the mid 90's so I don't think it's hypoxia....more likely mets to the brain....don't know how much more morphine we could give her...10mgs q2 hours seems like it should work.

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Specializes in ICU, ED, Transport, Home Care, Mgmnt.
Her 02 sats have been in the mid 90's so I don't think it's hypoxia....more likely mets to the brain....don't know how much more morphine we could give her...10mgs q2 hours seems like it should work.

That may not be enough Morphine for this lady. That is not much for a cancer patient with a lot of pain.

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Her 02 sats have been in the mid 90's so I don't think it's hypoxia....more likely mets to the brain....don't know how much more morphine we could give her...10mgs q2 hours seems like it should work.

one thing i have recently learned (in the past year) is that o2 sats can be very very misleading.

i've had copder's with sats in the 90's yet were still dyspneic and/or cyanotic.

many of these people with lung cancer or copd retain o2 so the sats that you're seeing doesn't necessarily reflect perfusion.

if her tissues aren't being perfused adequetely she could still have sats in the 90s so that's where abgs would be more reflective of perfusion status. i've had patients with o2 sats in the 90s who were diaphoretic, sob, and using accessory muscles to breathe. so sometimes we have to look at the patient and not these assistive devices.

10mg q2h might seem like a lot but i've given patients 50-100mg q hour and have tolerated quite well. morphine does not have a ceiling dosage...

so for someone with lung ca with mets, i would focus on increasing the morphine, making it scheduled if it's prn, and the haldol is a Godsend to many.

also, benadryl i thought was contraindicated in the elderly??? i thought it caused a paradoxical agitation. that's what i was told anyway.

leslie

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Specializes in cardiac ICU.

She's probably already getting this, but...Decadron to reduce cerebral edema?

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Totally correct Earle58!!! Remember to always go by the patient and not the machines!

A pulse ox only tells you if the hemoglobin is bound with something..not WHAT it is bound with! People tend to forget that little gem. I can go out and have a smoke and have 98-100%..but do you think that is all oxygen? People have also been misdiagnosed as having great pulse ox sats, when they really are suffering from carbon monoxide poisoning...CO2 has the same effect...

I also though..hmmmmmm lets check out to see if we are having a reaction with meds she is currenty on.

I had a patient that just recently had this very reaction, couldn't stop moving and the delusions were incredible. He passed before we had a chance to nail it down definitively...but I found it was his haldol causing much of the probelm by really taking a close look into his history and finding out he not only use to take a lot of haldol which was d/c'd for this probelm...but that his liver was filled with cancer and therefore not really getting the drugs out of the system..causing even worse probelms. And of course the brain mets...which is so sad..not too much you can do at that point but try your hardest to keep them comfortable...

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I have a patient...lung cancer...on hospice. She is dreadfully agitated. Won't sit still,won't keep her clothes on, can't eat. We have tried: Roxinal, Ativan, Thorazine, Compazine, ABHR suppositories, tylenol, massage, music, everything we can think of and still we can't help this poor woman.

Any ideas???

Have you ruled out all the obvious possibilities for the agitation? Have you tried Haldol to calm her? If her prognosis is

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