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How Much Morphine And Ativan Is Too Much When Do Comfort Measures On A Dying Patient.?
I’m a nurse, and I was taking care of a dying patient this week and the family wanted me to given morphine 2mg iv every hour and ativan 1 mg iv every other other. The patient was non-responsive and a respiratory rate of 8-10 with periods of apnea. I felt like giving this much was assisting in killing the patient. Is it ok to give this much?
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Often in this situation, if the patient is physically capable, they are given control of the medicines through a pump that is set to give large amounts of pain killers, but it does not allow the patient to overdose. For a nurse administering these drugs, its probably not a good idea to give excessive pain medication if the patient does not ask for it. If a patient is not capable of asking for pain medication, then its best to stick with a safe dosage since a non-responsive patient is not conscious of pain anyhow.
Whether or not this is OK depends on your own moral conscience, and how much legal liability you are willing to accept in the event that you end up contributing to the patient’s death. Its obvious that this dosage combination puts the patient at risk of death from respiratory failure. I personally would not take this risk since there is no benefit from medicating an responsive patient, and there is a significant personal risk.
Yes, it is as long as it is within the Dr’s orders. There is *no* upper limit to the use of morphine and ativan in a hospice situation.
Morphine is useful not only for pain but for air hunger. With periods of apnea like you are describing morphine is very beneficial.
If this is a hospice situation IMO there is really no amount of PRN narcotic that is too much if within Dr’s orders. This person is dying anyway, and it is the kindest thing to assume that there is pain and distress since they are incapable of advocating for themselves. It is a double reassurance that the family wants this done- I’ve taken care of hospice patients whos families have had totally unrealistic ideas about medication effects VS patient outcomes and it is terrible to see the suffering.
Those amounts are easily not considered too much for a patient in the last extremity- you also have to consider that this person may have been a long term user of opioids and ativan and thus have a marked drug resistance.
The ability you have to assist suffering, dying patients through the use of palliative care is a sacred and special duty.
Any questions you have can be answered here: http://www.hospicenet.org/
Take care, and thank you very much for the difficult work you do
EDIT- Normally I would agree with the above post, but you have made it clear that this is a palliative situation and so the methods and philosophy of treatment are totally different. Many in-hospital nurses will never run into this situation because most hospice patients are able to die at home or in an elder care facility.
That really is not alot of medication for a person who is on comfort measures. I think it is ok to give this amount, as it is ensuring the patient’s comfort. Of course, it is up to you, if you feel uncomfortable with this than perhaps a different nurse should care for the patient. With comfort measures, I always feel that it is up to the patient and family to dictate what they are comfortable with. If the patient is nonresponsive, and the family is requesting more medication, then you should give it. They know the patient, and they need to know that you will do what you can to make that patient comfortable. If it is a back rub, do it. A bath, do it, morphine and ativan, do it. It is definately ok to give those medications if they are ordered.
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