Morphine questions

RanchersWife

At the end did you give morphine as needed or on a schedule? She’s more alert as time passes. She pulls at blankets and turns her head. She also wakes herself up like when my kids were babies and tried to stay awake. She hasn’t eaten since Saturday and had hip surgery on Monday. She swallows some water every now and then. She also has some secretions starting to build up. I gave the pill to dry them up. 

I’m on the midnight to 4 am shift. It’s quiet and calm. 

Michael Ellenbogen

Is hard to say unless one knows if she can express her self with what is wrong and were. If not I would recommend morphine to insure, she is not in pain in any way. I no longer can tolerate any pain.

RanchersWife

Thank you Mr. Ellenbogen, you make a good point. I think that if I don’t know alertness/restlessness from pain I should assume pain and treat.

M1

RW, older people metabolize morphine so differently, it's easy to have it build up in their systems if you give it on schedule.  I'd probably vote for as needed and watch for restlessness as you are doing.  Hope things are going okay.

abc123

We are giving meds as needed. I know you will make the best choice for her. Thinking of you this morning.

May flowers

After my FIL had surgery, we gave oxycodone the first day or so, then Tylenol around the clock until he stopped grimacing/repositioning like he was uncomfortable. That seemed to be enough. But that was 2 months ago - when he was in great physical condition going into surgery. At this point, it might be different.

Do you think the not eating is a continuation from before or a side effect of anesthesia? I’m asking because my FIL ate very little the first week after surgery.

King Boo

Is your nurse visiting soon?  They should be able to answer your questions.  

I learned that signs of discomfort can be very subtle - a small furrow in the brow; a little bit more muscle tone that you wouldn't see unless you know to look for it.  

The dehydration that naturally comes along with the dying process (nothing to be treated) I was told can result in some achiness.   Which morphine can help.  

Generally, a schedule helps keep discomfort at bay, rather than letting it emerge then treating.

But of course, clinical eyes there from the nurse are best.

MN Chickadee

We did it as needed until my LO became what they call transitional in the last 48 hours. Then we gave it on a schedule (every 2 hours I think? it was such a blur.) Both because she seemed more comfortable that way, and also to time it 15 minutes before she needed to be re-positioned and messed with because that seemed to cause her great discomfort. Up until then the as needed seemed to be about every 4-6  hours, any longer and there were signs of pain. Definitely a furrow in the brow. Some grimacing here and there. I wouldn't try to trade alert for pain management since she can't tell you if she is uncomfortable. Given she isn't eating and drinking hardly anything for many days her body is getting ready to go and it seems likely she would be experiencing discomfort. Hopefully the hospice nurse is coming today and can give you guidance. Once they tell you she is transitional that kind of means it's go time and it won't be long. It is the phase right before active dying.

RanchersWife

I think the caregiver and I have figured out her cues. Pulling at blankets and restlessness called or Lazorapam (spelling) and grimacing and grabbing her dressing calls for morphine. I don’t know. I’m so exhausted and sad. I can’t sleep. I have a headache. I drank some wine. I forgot to eat today. I cleaned the house for visitors. I ordered pans of food to have. Our priest came and said a home mass for us.

Jo C.

It can be a difficult place to find oneself trying to guess at what is necessary for comfort levels with pain relief.  It appears it is probably sufficient to give the morphine in an as needed manner and continue with lesser meaures if they provide comfort. 

You are a very caring person who is being mindful of her LOs quality of life needs and are a very good advocate on your LOs behalf; she is blessed to have you by her side.

J.

ninalu

Thinking of you and your family RanchersWife.

I hope that you feel some peace and reassurance in the care and protection that you are providing your LO.