Terminal Agitation

[CapeCodMermaid]

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???

[CapeCodMermaid, RN]

We are a SNF and would not be allowed palliative sedation. She was on Haldol, and yes benadryl is usually contraindicated in the elderly...but she was only 67..Haldol and Thorazine are contraindicated in SNF's as well except in hospice cases. She had no s/s hypoxia...nail beds were not blue..no SOB...thankfully she passed away on Sunday and is now at peace. Thanks for all your suggestions...I'll remember the decadron for the next time.

[uamom52]

We are a SNF and would not be allowed palliative sedation. She was on Haldol, and yes benadryl is usually contraindicated in the elderly...but she was only 67..Haldol and Thorazine are contraindicated in SNF's as well except in hospice cases. She had no s/s hypoxia...nail beds were not blue..no SOB...thankfully she passed away on Sunday and is now at peace. Thanks for all your suggestions...I'll remember the decadron for the next time.

Hopefully she did not struggle at the end....could you have moved her inpatient for PS??? Decadron may have eased the swelling, but could have prolonged things.......Good luck

[BrandieRNq]

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.

CONSIDER THE REGLAN!!! Do a search on this board regarding Reglan and I think you will read descriptions that describe your pt.!!!

Once you stop the Reglan, it takes a bit to get it out of the system but the difference once off can be night and day.

[z's playa]

Ooohhh.....Decadron made me go haywire. If shes prone to anxiety like I am with many meds, you might not want to give her Decadron. Or at least watch her closely. Of course everyone reacts differently. I'm an exception with Decadron apparently.

[Antikigirl, ASN, RN]

CONSIDER THE REGLAN!!! Do a search on this board regarding Reglan and I think you will read descriptions that describe your pt.!!!

Once you stop the Reglan, it takes a bit to get it out of the system but the difference once off can be night and day.

I missed seeing the Reglan! Oh yes...I find that being a culprit more times than not! In fact, we just had a patient's reduced so it can be fully d/c'd and after a week the hallutionations and agitation has greatly improved! (pt has prostate ca met throughout now).