January 13, 2014 at 2:39 PM #11309
I work in a snf. There was a 91 y/o actively dying pt, on hospice. She had been unresponsive for 3 days, unable to eat. Family had been in and aware. All meds had been dc’d except roxanol and liquid ativan, which the orders were Q3hr prn. I had been very familiar with her and had taken care of her in the past and 2 days prior. She had a stage 3 on her sacrum. A brand new nurse had been taking care of her this day. I had asked her how this pt was doing. This nurse stated she was holding on and that she hasnt given her any morphine. I asked her why not and she stated she didn’t want to kill her. Would you have given her some to keep her comfortable? Any thoughts?January 13, 2014 at 8:13 PM #11311
Jason Hautala RNMember
Just because someone is too far out of it to communicate or even move, doesn’t mean they can’t hear you or feel pain and anxiety. You know she has some painful conditions, and you know most people would feel some type of anxiety over not being able to move and being close to death. For these reasons I would be giving the narcs and benzos as ordered to keep the patient comfortable. Yes, it may speed the process up, but unless the goal of your treatment is to keep her alive and cure her, then the goal should be to keep her comfortable.
I’ve held off on narcotics briefly for people who were actively bleeding out and didn’t have any blood pressure to mess with, but we were working hard to get a blood pressure back and save a life … but it doesn’t sound like this patient was intended to make a recovery, so if the goal of treatment ends with a dead patient, I think you should keep the patient as comfortable as possible during that process.
I would rather err on the side of giving medicines to someone who was so far out of it that they didn’t need it than to not give meds to someone who was silently suffering during their last days on this planet. When I’m that patient, give me lots and lots of pain meds.January 15, 2014 at 8:45 PM #11327
It IS SCARY for a brand new nurse to think of giving morphine. She should be made aware that in LTC, especially when to the hospice stage, the resident’s comfort and anxiety is ordered for comfort measures, not to hasten the dying process. The amounts ordered are safe, and should be given to an unresponsive person. It’s not something the patient should have to actively ask for at that point, even though it’s prn.January 16, 2014 at 5:05 PM #11336
I am a hospice nurse and I would have educated the new nurse on the reasons for administering the morphine. Unless you are familiar with hospice care it can be scary to give what you think is a lot of morphine. It is to maintain comfort and ease dyspnea in a dying pt. The patient not being responsive isn’t the point in this case, especially with a decubitus that you know is painful. It is also for the family to see that their loved one is at peace and comfortable. Nurses are natural healers, hospice nursing takes a purposeful change in mindset.
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