Hospice Patients Alliance – When It is Inappropriate to Have PRN Medical

#end stage copd hospice

#

Allowing PRN Orders for Morphine
May Result in Untimely Death
For COPD Patients

Morphine is an opioid medication often used to relieve severe pain in cancer and some other diseases. When prescribed by a physician appropriately for relief of pain, it is a blessing to those whose symptoms are relieved, and to the families of those patients who had suffered watching their loved one in agony. When the patient has severe pain, hospices aim at achieving good pain control as one of their top priorities.

Because morphine is regularly prescribed in hospices for relief of pain and suffering, physicians and nurses come to rely on its power to relieve pain and promote a death without suffering. A death with symptoms well-managed is one important aspect of what is called a “death with dignity.”

Patients in hospice who have diseases without severe pain may not need morphine for comfort. Some take other analgesics and some take none. But patients who have Chronic Obstructive Pulmonary Disease or “COPD” may especially be sensitive to the adverse effects of morphine. COPD patients have breathing difficulties and anxiety which can sometimes be lessened by very small dosages of a sedative and/or a very small dosage of morphine. However, given in too high a dose, morphine can seriously interfere with a patient’s ability to breathe. In fact, anyone who is given a dosage of morphine which is much higher than they are accustomed to, may stop breathing.

One of morphine’s main adverse effects is slowing down the respiratory rate, i.e. respiratory depression. If the dosage of morphine is too high for what the patient is accustomed to, the respiratory depression can become severe and actually stop the breathing periodically for a few seconds or many seconds. This pattern of breathing where the patient stops breathing (skipping breaths) and then starts breathing again is termed “apnea.” Apnea commonly occurs as a result of the terminal illness and the dying process, when certain metabolic changes occur in the patient’s body. If the breathing is stopped completely without restarting, the patient dies. Because COPD patients have compromised breathing already. very inefficient breathing, overly high doses of morphine can quickly cause these patients to stop breathing.

Hospice Patients Alliance has received many, many reports from families about patients with COPD who were given morphine in dosages higher than they were accustomed to receiving. who died shortly after getting those morphine dosages. Most of these patients were given these dosages of morphine by nurses in the hospice setting. In all the cases reported, the physician had ordered that the morphine might be given “as needed” or “PRN” within a certain range and at a certain frequency of time intervals between doses given.

Giving a medication “as needed” requires a careful assessment of the patient’s vital signs, pain level and need for the medication being considered. When a physician writes a PRN order for morphine, most nurses are very dedicated to assessing the patient’s actual needs and doing everything possible to meet those needs by administering the medication as needed. But in the case of COPD patients, the need for extra vigilance in determining the appropriate dosage is very urgent. Pharmacy and drug references, such as the Physicians Desk Reference and morphine package inserts warn about the dangers of giving too high dosages of morphine to COPD patients. The package inserts and the Physicians Desk Reference even write that morphine is “contraindicated” in general for COPD patients. However, when a patient is truly terminal, some of the rules of prescribing medications are adjusted to meet the needs of the patient. In the terminal COPD patient, morphine is sometimes ordered by the physician to be given in very small dosages.

If the physician orders the morphine to be given on a PRN or “as needed” basis, when the patient has COPD, and allows a shorter frequency of administration than that needed for the previous dosage to “wear off” or be metabolized, the concentration of morphine actually in the patient’s blood may increase beyond a therapeutic level, causing severe adverse effects, even respiratory shutdown. If you have a loved one with COPD in a hospice care setting and if you are concerned that he may be euthanized before his natural time of passing on, then it is wise to request that the physician NOT write a PRN order for morphine. If the morphine is actually helping your loved one to breathe better, and is comforting, then you may wish to request the physician to consider ordering the morphine on a fixed dosage and schedule, determined by the physician only, not the nurse.

If you have concerns that your loved one may be medically killed or euthanized in a hospice setting, you should discuss these concerns with the physician and request that PRN orders for morphine not be used. If the physician refuses to do so, you may be able to determine whether the physician is sympathetic to your concerns about euthanasia or not. If you believe the physician is determined to euthanize your loved one, involuntarily, or without your knowledge, then you always have the right to change physicians or to change hospices. Any time that you have concrete evidence that a nurse or physician is acting to euthanize your loved one, the patient, or the patient’s representative may act to change the physician and hospice to a setting that will provide true hospice care.

Real hospice care is NOT about hastening the death of a patient. It is about providing relief from distressing symptoms, supporting the patient and letting them know that they are valued and loved. Hospice patients necessarily choose not to try to cure the terminal illness, because all efforts to cure the disease are believed to have failed and further efforts are believed to be of no use in curing the disease, i.e. the physician has determined that no efforts would succeed in any case. That does NOT mean that treatment for a urinary or respiratory infection is to be withheld, or that food and water are to be withheld if the patient can absorb them. Withholding food and water is a form of euthanasia for the patient who is not already actively dying! Withholding appropriate treatment for an infection when the patient is not actively dying is also a form of euthanasia!

Giving overly high dosages of morphine to a COPD patient, or a patient with another terminal illness, is a form of euthanasia. By being alert, discussing your concerns with the physician and hospice staff and acting promptly to prevent overly high dosages of morphine from being administered, you can save your loved one from an untimely death. Removing your loved one from a setting that is bent on euthanizing your loved one may be the only way to save them from being medical killed.

There are many nurses and physicians who would never even think of doing such a thing, but unfortunately, there are many who would. Surveys and research into the attitudes and practices of physicians and nurses reveals that a significant percentage of nurses and physicians believe that euthanasia is acceptable. If you don’t agree, then you must act to protect your loved one. The best protection is to know what medications are being given, what effect the medications have, what dosages are being given (by being there if possible when they are given) and knowing why the medications are being given. If your instincts tell you that something is not right, act promptly to check with someone you trust who is a nurse, pharmacist or physician who can give you some feedback and further information.

PRN orders for morphine may be totally inappropriate for COPD patients who do NOT have severe pain!

Permission is granted to share these articles with others, to print them, or post them on other websites so long as credit
is given to the author and Hospice Patients Alliance with a link to this original page.





Hospice, Morphine and Preparing for Traditional Catholic Death #motels #in #las #vegas

#catholic hospice

#

The first Hospice was started by the Catholic Sisters of Charity in London England in 1905 to help people who did not have a place to die. It was called St. Joseph s hospice because St. Joseph is the patron of the dying. I think the sisters who founded it came from Ireland where there was a similar place. So it is wonderful to have help with terminally ill patients in their last days.

Hospice offers support to people who would like to die at home or die at one of their homes. They give medical advice and a visiting nurse comes once a week. You can call them 24 hours a day to get advice. But you still have to do almost all of the taking care of the sick person in all the day to day activities. Many think Hospice will do everything which is not true.

If you die at home and are signed up with Hospice, you just call them when the person has died and they do the pronouncement of death. This avoids the need to call the paramedics, who are obliged by law in many places, to do CPR on any person who dies at home. It also avoids having to have an autopsy with the coroner (sheriff Department). If someone dies suddenly at home you usually need an autopsy to rule out the possibility of any foul play.

All this said, Hospice has helped a lot of people. But recently it is changing to become an accomplice with Euthanasia. I say this because of the many many people I have done the funerals for and of whom I have visited in their homes under the supervision of Hospice.

An example of this is when we get the clergy record with the funeral, the cause of death put down is Alzheimer. Alzheimer does not kill anyone. Or we will see pneumonia. If you have pneumonia, you need to go to the hospital to get antibiotics, not put on hospice to die.

What happens many times is that the family is told that the patient should not drink or eat because they will aspirate. That means, food or liquids will go into their lungs and cause pneumonia. Well that is a danger, but besides dying from pneumonia, you can die from no water or food.

The Catholic Church s teaching is that you are to give ordinary things to a terminally ill person like medicine, water and food. You do not need to put in a feeding tube, unless it is advantage for the recovery of the sick person. You do not to be put on the breathing machine either or resuscitated. These are extraordinary means to keep people alive.

But people who are terminally ill and still have many months to live can not used things that will hasten their death just because some day it will arrive.

Two extremely important principles to remember are 1) Life is precious and should be sustained if at all possible and 2) Always do what the terminally ill patient wants as long as it is consistent with Catholic teaching. For example, if the terminally ill patient wants to be resuscitated after heart failure, or be intubated on a breathing machine, there is nothing wrong with that because Life is precious and the persons wishes should be respected.

Now the problem I and other priests have observed is that when people are on Hospice care, they push morphine to much. A healthy old man, whom I was visiting on a regular basis, was put on Hospice. He was agitated and out of his mind. But was not terminally ill. The hospice people got mad at the family for not giving him the morphine he refused to take. So often they tell the family that the person is in pain. I have asked many if they are in pain and they respond no. Yet Hospice insists on giving them morphine on the basis that more than likely they are in pain and not expressing it.

This is very dangerous, because the family taking care of the sick person or old person who is crazy with Alzheimer, get very tired. And when they are told by a medical authority, like Hospice, that they should give them morphine, people tend to give in and obey even when the patient is not terminally ill.

We traditional Catholics do not want to see terminally ill persons in pain. God has given us the gift of morphine to help relieve pain. It is a good. But the danger comes when it is used to put people in a drugged state, who are not dying, and then they can no longer pray, eat or drink.

Over and over again I try to hear confessions of people who have not gone to confession in years and want to confess as they lie dying. But because of the morphine, can not stay awake to confess. I shake them, I holler at them, anything I can do to get them to make a good confession. But it is very hard, because they keep falling asleep. Please call the priest before they are on morphine.

So if you are dying anyway from a terminal disease, it is fine to use pain killers to relieve the pain even it it might speed up the natural process. But it should only be used to relieve pain and not to control people with Alzheimer or other normal health conditions that come from old age.

All of us will be dying some day. Do we want to be put on morphine and drugged out of our state of consciousness? I do not think so. We need to have this very clear with all those who love us and will be caring for us in our old age.

All the saints dreaded being fooled by the devil at the last part of their holy lives by the devil. We who are by no means saints, should have more dread of being drugged out when that decisive moment happens as we approach death.

It is so important to have health care directives written out for your family to follow.

To summarize: we want to live as long as we can and until God calls us. We want to be alert and conscious as much as possible to pray as we make our final journey to God. We do not need extra ordinary means (machines or resuscitation). But food, water and medicine are ordinary means of keeping alive. We can take pain killers if they are needed, but need to balance this with our desire to be alert to pray and repent of our sins.

No related posts.





Hospice, Morphine and Preparing for Traditional Catholic Death #palliative #care #uk

#catholic hospice

#

The first Hospice was started by the Catholic Sisters of Charity in London England in 1905 to help people who did not have a place to die. It was called St. Joseph s hospice because St. Joseph is the patron of the dying. I think the sisters who founded it came from Ireland where there was a similar place. So it is wonderful to have help with terminally ill patients in their last days.

Hospice offers support to people who would like to die at home or die at one of their homes. They give medical advice and a visiting nurse comes once a week. You can call them 24 hours a day to get advice. But you still have to do almost all of the taking care of the sick person in all the day to day activities. Many think Hospice will do everything which is not true.

If you die at home and are signed up with Hospice, you just call them when the person has died and they do the pronouncement of death. This avoids the need to call the paramedics, who are obliged by law in many places, to do CPR on any person who dies at home. It also avoids having to have an autopsy with the coroner (sheriff Department). If someone dies suddenly at home you usually need an autopsy to rule out the possibility of any foul play.

All this said, Hospice has helped a lot of people. But recently it is changing to become an accomplice with Euthanasia. I say this because of the many many people I have done the funerals for and of whom I have visited in their homes under the supervision of Hospice.

An example of this is when we get the clergy record with the funeral, the cause of death put down is Alzheimer. Alzheimer does not kill anyone. Or we will see pneumonia. If you have pneumonia, you need to go to the hospital to get antibiotics, not put on hospice to die.

What happens many times is that the family is told that the patient should not drink or eat because they will aspirate. That means, food or liquids will go into their lungs and cause pneumonia. Well that is a danger, but besides dying from pneumonia, you can die from no water or food.

The Catholic Church s teaching is that you are to give ordinary things to a terminally ill person like medicine, water and food. You do not need to put in a feeding tube, unless it is advantage for the recovery of the sick person. You do not to be put on the breathing machine either or resuscitated. These are extraordinary means to keep people alive.

But people who are terminally ill and still have many months to live can not used things that will hasten their death just because some day it will arrive.

Two extremely important principles to remember are 1) Life is precious and should be sustained if at all possible and 2) Always do what the terminally ill patient wants as long as it is consistent with Catholic teaching. For example, if the terminally ill patient wants to be resuscitated after heart failure, or be intubated on a breathing machine, there is nothing wrong with that because Life is precious and the persons wishes should be respected.

Now the problem I and other priests have observed is that when people are on Hospice care, they push morphine to much. A healthy old man, whom I was visiting on a regular basis, was put on Hospice. He was agitated and out of his mind. But was not terminally ill. The hospice people got mad at the family for not giving him the morphine he refused to take. So often they tell the family that the person is in pain. I have asked many if they are in pain and they respond no. Yet Hospice insists on giving them morphine on the basis that more than likely they are in pain and not expressing it.

This is very dangerous, because the family taking care of the sick person or old person who is crazy with Alzheimer, get very tired. And when they are told by a medical authority, like Hospice, that they should give them morphine, people tend to give in and obey even when the patient is not terminally ill.

We traditional Catholics do not want to see terminally ill persons in pain. God has given us the gift of morphine to help relieve pain. It is a good. But the danger comes when it is used to put people in a drugged state, who are not dying, and then they can no longer pray, eat or drink.

Over and over again I try to hear confessions of people who have not gone to confession in years and want to confess as they lie dying. But because of the morphine, can not stay awake to confess. I shake them, I holler at them, anything I can do to get them to make a good confession. But it is very hard, because they keep falling asleep. Please call the priest before they are on morphine.

So if you are dying anyway from a terminal disease, it is fine to use pain killers to relieve the pain even it it might speed up the natural process. But it should only be used to relieve pain and not to control people with Alzheimer or other normal health conditions that come from old age.

All of us will be dying some day. Do we want to be put on morphine and drugged out of our state of consciousness? I do not think so. We need to have this very clear with all those who love us and will be caring for us in our old age.

All the saints dreaded being fooled by the devil at the last part of their holy lives by the devil. We who are by no means saints, should have more dread of being drugged out when that decisive moment happens as we approach death.

It is so important to have health care directives written out for your family to follow.

To summarize: we want to live as long as we can and until God calls us. We want to be alert and conscious as much as possible to pray as we make our final journey to God. We do not need extra ordinary means (machines or resuscitation). But food, water and medicine are ordinary means of keeping alive. We can take pain killers if they are needed, but need to balance this with our desire to be alert to pray and repent of our sins.

No related posts.





Roxanol (Morphine Sulfate): Side Effects, Interactions, Warning, Dosage & Uses #sue #ryder

#roxanol hospice

#

What are the possible side effects of morphine (Avinza, Kadian, MS Contin, MSIR, Oramorph SR)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • shallow breathing, slow heartbeat;
  • stiff muscles, seizure (convulsions);
  • cold, clammy skin;
  • confusion, unusual thoughts or behavior;
  • severe weakness, feeling like you might pass out;
  • trouble swallowing;
  • urinating less than usual or not at all;
  • pale skin.

What are the precautions when taking morphine sulfate (Roxanol)?

Before taking morphine, tell your doctor or pharmacist if you are allergic to it; or to other narcotic pain medications (such as codeine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, lung diseases (such as asthma, chronic obstructive pulmonary disease-COPD), breathing problems (such as slow/shallow breathing, sleep apnea), a certain spinal problem (kyphoscoliosis), certain heart problems (irregular heartbeat), personal or family history of regular use/abuse of drugs/alcohol, brain disorders (such as seizures, head.

Last reviewed on RxList: 8/22/2007
This monograph has been modified to include the generic and brand name in many instances.





Roxanol (Morphine Sulfate) Drug Information: Indications, Dosage and How Supplied – Prescribing

#roxanol hospice

#

DOSAGE AND ADMINISTRATION

CAUTION. Roxanol (Morphine Sulfate 20 mg/mL) is a HIGHLY CONCENTRATED solution of Morphine Sulfate for Oral Administration.Error in dosage or confusion between milligrams (mg) of morphine and milliliters (mL) of solution may cause significant over-dosage. Dosing instructions should be clearly pre-scribed in milligrams (mg) of morphine and milliliters (mL) of solution. VERIFY CORRECT DOSE AND VOLUME BEFORE ADMINISTRATION TO PATIENT .

Usual Adult Oral Dose

10 to 30 mg every 4 hours or as directed by physician. Dosage is a patient dependent variable, therefore increased dosage may be required to achieve adequate analgesia .

For control of severe, chronic pain in patients with certain terminal diseases, this drug should be administered on a regularly scheduled basis, every 4 hours, at the lowest dosage level that will achieve adequate analgesia.

Note. Medication may suppress respiration in the elderly, the very ill, and those patients with respiratory problems, therefore lower doses may be required.

Morphine Dosage Reduction

During the first two to three days of effective pain relief, the patient may sleep for many hours. This can be misinterpreted as the effect of excessive analgesic dosing rather than the first sign of relief in a pain exhausted patient. The dose, therefore, should be maintained for at least three days before reduction, if respiratory activity and other vitals signs are adequate.

Following successful relief of severe pain, periodic attempts to reduce the narcotic dose should be made. Smaller doses or complete discontinuation of the narcotic analgesic may become feasible due to a physiologic change or the improved mental state of the patient.

HOW SUPPLIED

Roxanol
Morphine Sulfate (Immediate Release)
Oral Solution (Concentrate)

NDC 66479-560-03: Bottles of 30 mL with calibrated dropper.

NDC 66479-560-12: Bottles of 120 mL with calibrated dropper.

NDC 66479-560-24: Bottles of 240 mL with calibrated spoon.

Store at 25 C (77 F);excursions are permitted to 15 -30 C (59 -86 F) [See USP Controlled Room Temperature]

DEA Order Form Required.
ROXANOL (morphine sulfate) is a trademark of Xanodyne Pharmaceuticals, Inc.
2005 Xanodyne Pharmaceuticals, Inc. Manufactured by: Boehringer Ingelheim Roxane, Inc. Columbus, OH 43216
Marketed by: Xanodyne Pharmaceuticals, Inc. Newport, KY 41071. Rev.10-2005. FDA rev date:

This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 8/22/2007





Hospice, Morphine and Preparing for Traditional Catholic Death #low #price #hotel

#catholic hospice

#

The first Hospice was started by the Catholic Sisters of Charity in London England in 1905 to help people who did not have a place to die. It was called St. Joseph s hospice because St. Joseph is the patron of the dying. I think the sisters who founded it came from Ireland where there was a similar place. So it is wonderful to have help with terminally ill patients in their last days.

Hospice offers support to people who would like to die at home or die at one of their homes. They give medical advice and a visiting nurse comes once a week. You can call them 24 hours a day to get advice. But you still have to do almost all of the taking care of the sick person in all the day to day activities. Many think Hospice will do everything which is not true.

If you die at home and are signed up with Hospice, you just call them when the person has died and they do the pronouncement of death. This avoids the need to call the paramedics, who are obliged by law in many places, to do CPR on any person who dies at home. It also avoids having to have an autopsy with the coroner (sheriff Department). If someone dies suddenly at home you usually need an autopsy to rule out the possibility of any foul play.

All this said, Hospice has helped a lot of people. But recently it is changing to become an accomplice with Euthanasia. I say this because of the many many people I have done the funerals for and of whom I have visited in their homes under the supervision of Hospice.

An example of this is when we get the clergy record with the funeral, the cause of death put down is Alzheimer. Alzheimer does not kill anyone. Or we will see pneumonia. If you have pneumonia, you need to go to the hospital to get antibiotics, not put on hospice to die.

What happens many times is that the family is told that the patient should not drink or eat because they will aspirate. That means, food or liquids will go into their lungs and cause pneumonia. Well that is a danger, but besides dying from pneumonia, you can die from no water or food.

The Catholic Church s teaching is that you are to give ordinary things to a terminally ill person like medicine, water and food. You do not need to put in a feeding tube, unless it is advantage for the recovery of the sick person. You do not to be put on the breathing machine either or resuscitated. These are extraordinary means to keep people alive.

But people who are terminally ill and still have many months to live can not used things that will hasten their death just because some day it will arrive.

Two extremely important principles to remember are 1) Life is precious and should be sustained if at all possible and 2) Always do what the terminally ill patient wants as long as it is consistent with Catholic teaching. For example, if the terminally ill patient wants to be resuscitated after heart failure, or be intubated on a breathing machine, there is nothing wrong with that because Life is precious and the persons wishes should be respected.

Now the problem I and other priests have observed is that when people are on Hospice care, they push morphine to much. A healthy old man, whom I was visiting on a regular basis, was put on Hospice. He was agitated and out of his mind. But was not terminally ill. The hospice people got mad at the family for not giving him the morphine he refused to take. So often they tell the family that the person is in pain. I have asked many if they are in pain and they respond no. Yet Hospice insists on giving them morphine on the basis that more than likely they are in pain and not expressing it.

This is very dangerous, because the family taking care of the sick person or old person who is crazy with Alzheimer, get very tired. And when they are told by a medical authority, like Hospice, that they should give them morphine, people tend to give in and obey even when the patient is not terminally ill.

We traditional Catholics do not want to see terminally ill persons in pain. God has given us the gift of morphine to help relieve pain. It is a good. But the danger comes when it is used to put people in a drugged state, who are not dying, and then they can no longer pray, eat or drink.

Over and over again I try to hear confessions of people who have not gone to confession in years and want to confess as they lie dying. But because of the morphine, can not stay awake to confess. I shake them, I holler at them, anything I can do to get them to make a good confession. But it is very hard, because they keep falling asleep. Please call the priest before they are on morphine.

So if you are dying anyway from a terminal disease, it is fine to use pain killers to relieve the pain even it it might speed up the natural process. But it should only be used to relieve pain and not to control people with Alzheimer or other normal health conditions that come from old age.

All of us will be dying some day. Do we want to be put on morphine and drugged out of our state of consciousness? I do not think so. We need to have this very clear with all those who love us and will be caring for us in our old age.

All the saints dreaded being fooled by the devil at the last part of their holy lives by the devil. We who are by no means saints, should have more dread of being drugged out when that decisive moment happens as we approach death.

It is so important to have health care directives written out for your family to follow.

To summarize: we want to live as long as we can and until God calls us. We want to be alert and conscious as much as possible to pray as we make our final journey to God. We do not need extra ordinary means (machines or resuscitation). But food, water and medicine are ordinary means of keeping alive. We can take pain killers if they are needed, but need to balance this with our desire to be alert to pray and repent of our sins.

No related posts.