Hospice Nurse

When do you decide to give a patient morphine?

Asked by DA almost 11 years ago

A number of circumstances warrant the use of morphine.  Palliative care providers are trained and certified in the palliative care and again this profession is a calling and you just "know" when the time comes.  But when the patient has uncontrolled pain not being relieved by other means of pain control I will occasionally switch to morphine.  Also when a patient becomes unable to swallow the sublingual drops of morphine are the most effective pain treatment.  Not all hospice patients get morphine that is a misconception.  I have had a number of hospice patients that were not in need of morphine but simply sublingual Ativan, Valium etc for terminal agitation related to the changes in the body and lack of oxygen and blood being pumped to the brain as the heart begins to weaken.  Also pain patches are effective for those not in severe pain but do require steady pain control.  I like this method because SL Morphine is fast acting short lived and doses have to be repeated frequently.  This occasionally is stressful for the caregiver too.  So with an anxious caregiver I may use other methods.  You have to evaluate the situation and it is a holistic approach with the patient being first priority but the caregivers and family being right next in line.  You treat the patient and the family is ALWAYS involved in the careplan for the patient.  I like to have decisions made while a patient is still alert and oriented and document their wishes and preference for pain control and usually have caregivers present during the discussion so that we have no question of which method to provide.  Hope that answers your quesiton.  Sorry for the delay I have been dealing with MS. So sorry

How long will someone last without food and water in a coma from an aneurysm in may. Off feeding tube for 7 days now. Only 61 yr. No fluids and breathing on her own with a trac

Asked by SK over 10 years ago

I am so sorry for this delay.  I have been dealing with MS. You may not even need an answer to this question.  As crazy as it sounds this varies for each patient.  Just as we are all born differently, some easy births, some difficult, some come into the world screaming, some never cry, we also die uniquely. For instance, in this case, pending this person has no fluids, as you stated, no feedings running, and not even minimal sips of fluids, normally they survive up to two weeks or so.  Without any type fluids, food, etc normally death will occur within 72 hours.  However, in my experiences with hundreds and hundreds of patients, it depends.  It depends on the persons will to live, like a mother having fear of leaving her children.  A father not wanting to leave his children but much more not wanting to leave behind the wife who never worked and stayed home rearing the family.  Mothers of small children seem to fight death to a point that has amazed me and it goes way beyond any type of education and experience I have ever recieved.  Also people with very stubborn personalities and very strong willed people tend to survive longer.  So sorry for the delay hope this helps.

I've invented a new approach to managing the spread of germs & viruses without the need for chemicals. It's called a Coughy Cup dot com. It captures, contains & filters 99% of the germs & viruses from coughing. What do you think for your profession?

Asked by John Delatorre over 10 years ago

This is very interesting.  That is hard to answer because I am not familiar with this invention or how it is used.  A hospice patient, at a certain point would not be able to use the device, depending on how it is used.  The reasons being weakness, disorientation, and eventually a comatose state.  However, it probably would be a wonderful thing to present from a caregiver standpoint. Normally hospice patients in the end state are not going to catch "bugs" etc and normally at this point it is of no concern.  I know that sounds horrible but what I mean is, at the point of inevitable pending death and as it nears, the focus is NOT whether or not they catch a cold or anything else, it is to have loved ones around and proper palliative care to ensure a peaceful passing.  Make sense? BUT if you wanted to present that to hospice companies, try the approach for the hospice patient that is alert and oriented with lung issues, pneumonia etc to prevent spread to a caregiver and present it to suggest to caregivers.  Also I would suggest to promote it for the employees, especially your CNAs that spend MORE time with the patients and families due to the job they do.  It is more up close for more time due to bathing the patient etc.  We all know we cannot call in everytime we have a simple cough or cold and this could easily be a good thing to be utilized by hospice providers to prevent spread of "bugs" to a patient.  Use the phrase, to prevent facilitating the dying process secondary to spread of germs and infecting your patients. :)) hope this is helpful to you.  Also I am a Multiple Sclerosis sufferer, our treatments break down our immune system and almost every single thing we come into contact with makes us sick.  Present this invention to doctors that treat patients with autoimmune disease and cancer.  Reasons, chemo and medications for autoimmune disease break down the immune system. Best of luck with this :)

I had to come back and edit this answer because if you could later come up with an idea to push for chronic lungers etc that cough even while comatose, a gadget that can be utilized for them, almost like an oxygen mask with a filter or whatever you use in the cup in a bag? Like an ambu bag? Just FYI I am no inventor haha Just hospice nurse ;)

What do you do if you realize that your hospice patient's pain meds are getting stolen by family members?

Asked by chad about 11 years ago

Oh my, it happens so frequently.  As protocol we get the Social Worker involved and meet with the family.  We can choose to report to authorities but normally, unless it is a major issue and habitual, we opt not to have others involved.  The reason is because the last thing a dying person needs is chaos and drama.  They do not need to have loved ones being shipped off to jail during the dying process.  One company I worked for we would remove all narcotics etc from the home and an on call nurse HAD to make visit each time the patient needed medications.  I have had to resort to a pain pump in the past to prevent such.  Also the transdermal patches help because it is quiet difficult to turn a patient and remove a patch for self gratification.  I placed the patch on my patient normally on the backside somewhere and initialed and dated it.  Also I always always make the families aware that I monitor my patients' medications each visit and count them.  The patches normally are five to a box and I monitored those as well. Sorry for the delay I have been dealing with my MS and treatments.

So a friend of mine used to work at a hospice and now another friends father is there. The friend that worked there said the nurses leave meds out and has pics she also said they throw used needles in the dumpster and hide them when inspectors come.

Asked by curious about 10 years ago

When I worked we had in services constantly to ensure compliance with state! All hospices or any medical field must provide info on how to report non compliance! I am not sure of how to ensure you get to the correct people without possibly checking that particular companys website. But there is a link 

Have you ever had several family members wanting different things for the patient? How did you deal with this and how did they come to an agreement?

Asked by 12ac about 10 years ago

I can't decide if hospice is right for me, I love the idea of helping people and I know all that hospice care does thats what I want to do but I don't know I just can't make a final decision. any advise?

Asked by haley123 almost 6 years ago