terminal sedation

[shearernurse]

Sorry, I don't know if this should be here or on a palliative care, or where my post should go, but here goes. I work in a 16 to 24 bed hospital depending on the day. Last night we had a bariatric pt come from our LTC facility with pneumonia and in my opinion she was fading fast. We gave her Fentanyl 100mcg S.L. q1h for pain 6 times on an 8 hour shift, the pt was basically comatose prior to the Fentanyl and yet she moaned incessently, which of course bothered the family. The family came out to talk to me and asked "what should we do". The only thing I could come up with was either a Versed infusion or continue what we were doing with the Fentanyl q1h. I told them the benefits and of course the probable outcome and they seemed ok with that. Her respirations were anywhere from 24-36.

During my report this AM, I mentioned that I had talked to the family about terminal sedation and they seemed to be in agreement. There seemed to be a shocked silence in the room at the mere thought I should mention something like this to the family. Did I have the right to have that conversation with the family? The look my head nurse gave me said I should be pushing up daisies. I feel I did the best I could with information I had and the family did seem appreciative

shearernurse

[EMSnut45, BSN, RN, EMT-P]

As nurses, we do not "terminally sedate." We treat symptoms. If the patient is in pain, we medicate for pain. If they are anxious, we medicate for anxiety, etc. The only difference between medicating an end of life patient and a patient that we are trying to make better is the end goal. With end of life patients, we focus only on symptom management and not on the side effects of the mediation (for example respiratory depression is not taken into consideration if the patient still appears to be in pain).

Sorry, I'll step off my soap box now. I just hate the negativity that medicating end of life patients has. My mother frequently calls me "Killer" when I talk about how I medicate end of life patients. I do not kill them. Their disease process does, and I make sure to provide them with a comfortable and dignified death.

If I were you, I may have advocated for morphine instead of fentanyl. Morphine provides an anoxilytic effect as well as the respiratory suppression for air hungar and pain management. Fentanyl really only targets the pain management and is very short acting. If the patient was anxious, I may have asked for some ativan (versed is very short acting).

I am frequently involved with end of life patients in the ICU, and I can honestly say that it takes a while to get comfortable with how to treat end of life symptoms and get a feel for what medications to use for what symptoms and in what dose.

Let me know if you have any questions. There are several active hospice nurses on here as well that may be of some help to you.

EMSnut