What can i do?

RNperdiem, RN · Aug 29, 2007

This is a difficult situation. Is there any family members involved with her, and what do they think?

busy-bee · Aug 29, 2007

Is the patient enrolled in hospice? Sounds like she needs to be if she isn't. Hospice should be able to supply adequate pain relief. If she is on hospice it sounds like maybe she has decided to pass at home, and if this is the case her wishes are her wishes. Pain control and infection control would be my main concerns. Maybe you can speak with her family and hospice regarding those two concerns and any others you may have.

Dolce, RN · Aug 29, 2007

Poor woman. Hospice needs to be involved. She does not need to be admitted to the hospital for morphine. But, she does need more adequate pain relief.

tigress_8207, ASN, BSN · Aug 31, 2007

Yes she is in hospice but the pain meds the doc ordered don't do much.Says there's nothing else that can be done for her unless she is admitted to hospital.Oh and haven't seen any relatives or friends yet.

Sailingshoes · Aug 31, 2007

Oxycontin and Roxanol I assume is already being used? Hospice should be all over it, right?

brwneyegal · Sep 2, 2007

If she is enrolled in hospice what about sub q morphine. Or even a sub q pump to help elevate the pain. This should be addressed by the hospice nurses and the doctors no pt should have to suffer with pain.

Daytonite, BSN, RN · Sep 2, 2007

Hi all.Elderly pt,early 90's,masectomy of left breast,Swollen decaying right breast.This pt refused to have the breast removed not sure how long it's been like that as this is my 2nd week there.Well pt is in extreme pain.Has a prescription for pain killers which don't do much and refuses to go to hospital for morphine.I was told she does'nt have much longer but i hate seeing her in so much pain and knowing there's nothing i can do to help.Is there anyway i can convince her to go to hospital?

No. You can't make anyone do anything they don't want to do. The only way I've ever seen this overcome is when someone goes to court, gets a guardianship and can make the decision for the patient. However, there has to be a good reason for a judge to take away a person's right to make their own healthcare decisions.

I had a patient situation similar to this many years ago. Patient threw a clot to one of her legs and it was turning gangrenous. She and her husband refused to let the docs go in and attempt to remove the clot. As the leg got worse they refused an amputation. For almost 3 weeks we all handled that leg with kid gloves while it developed these huge black fluid filled blisters. We knew if one of them broke open that she would be in deep trouble with an infection. Meanwhile, the leg went from dusky, to cyanotic to almost black. Finally, her pain was so bad the woman was literally screaming continuously because no pain medication was working. The doctors were able to convince both her and the husband that the leg had to go. Part of the problem, I think, was the husband was an alcoholic and seemed to be very confrontational with everyone. He constantly threatened to sue everyone on the planet if anyone went against his or his wife's wishes. Well, suffering must have been what they wanted and suffering was what they got. It didn't have to be that way though.

Tweety, BSN, RN · Sep 2, 2007

I agree that Hospice should be involved.

In addition to the above suggestions for roxinol, oxycontin, po morphine, fentalyl patches might be of help as well.

CHATSDALE · Sep 2, 2007

horrible situation..she may have outlived everyone who could stand up and make decisions for her

EmmaG, RN · Sep 2, 2007

Why in the world would she have to be admitted to the hospital in order to get morphine (or adequate pain relief)?

Your hospice doc leaves a lot to be desired.