There are also different brands of morphine. Short acting morphine lasts for 2 to 4 hours per dose. Most people start on a short acting morphine tablet or liquid. This is because it is easier and quicker to adjust the dose. Once your pain is under control, you might change to a long acting or slow release tablet or capsule. If you are taking it twice a day, you should take it in the morning and at night, for example at 8am and 8pm. It is important that you take morphine regularly, even if you don't feel pain.
The slow release tablets or capsules can take up to 48 hours to give you a steady dose. So if you stop and start, they won't work so well.
There are different brands of liquid morphine such as Oramorph short acting and MST Continus suspension long acting powder for dissolving in water. When you can't swallow or are feeling sick, you can have morphine as an injection. There are different ways of having morphine injections such as under the skin subcutaneous , into a muscle intramuscular or into a vein intravenous.
You might have stinging or a dull ache for a short time after this type of injection, but they don't usually hurt much. The skin in the injection site may also go red and itchy for a while. Some people have morphine under the skin continuously through a small needle connected to a pump called a syringe driver. It gives a continuous small volume of morphine. Your nurse will change the syringe driver every 24 or 48 hours. This way of having morphine is helpful for people who find it difficult to swallow.
You can have morphine into your bloodstream. You usually have it through a thin, short tube a cannula put into a vein in your arm or the back of your hand. Or you may have it through a central line, a portacath or a PICC line. Your doctor or specialist nurse will help you choose the type and dose that best controls your pain. It depends on the pain you have and the amount of drug you need to control it. You may feel drowsy when you first start taking morphine or if the dose is increased.
He also has a fentanyl patch. He was his version of normal before that combination was given to him. If he still looks uncomfortable or is having symptoms, you can talk to the hospice team about whether it would make sense to try more pain medication or something else to manage his distress versus adding the lorazepam. Going slowly with the medications is usually reasonable.
Good luck and take care! I came across an article about a randomized, double-blind crossover trial of morphine as an aid to breathing that showed morphine is NOT a useful treatment for breathlessness.
I would be glad to share the citation with you and others. Almost all the subjects suffered adverse side effects from the morphine. Please do share the citation so that I and other readers can evaluate it.
I have cited in the article a Cochrane review article, which covers multiple studies, and they concluded that there is some evidence supporting opioids for breathlessness. I am very concerned about the treatment my loved one recently received at an inpatient hospice facility.
The staff came out to her home to evaluate her in the second week of July. Until that time, she had been mobile, eating small amounts, drinking, laughing, and interacting quite a bit. She was showing signs of dementia and was unable to regulate her own medication at this time. She was also having anxiety related to her breathing COPD , but seemed to be coping fairly well.
She had always been the restless type, never sitting still for any length of time. Once hospice evaluated her, they started her on Ativan and Morphine the first day. She had a sudden onset of hallucinations that we had not seen in her before.
We tried to alert the staff that this was unusual for her and had just occurred since the drug change. The staff members told us this was normal and attributable to her metastatic cancer. My loved one was then admitted to hospice inpatient care. My loved one was trying to get out of the bed and saying that she wanted to go home. She had always been tenacious and had never wanted to stay in one place for long, especially not in bed all day, so this was very much in line with her personality.
Also, it was an intermittent occurrence. Other times she could be sitting still, interacting with a visitor, laughing and listening to music. A pastor even made the comment that she calmed down when he put his hand on her shoulder. The staff refused to listen to our concerns and a family member agreed to allow them to add medications to counteract her restlessness. To me this appeared to be an attempt at chemical restraint.
I would describe this stage as intermittent palliative sedation. After five days, the staff requested the addition of an analgesic drip of Ketamine.
Before the Ketamine drip was administered, despite all of the other drugs, our loved one was still enjoying some quality time with visitors, drinking, and eating a small amount. After the staff added the Ketamine, our loved one became barely responsive and began aspirating anything by mouth.
She died nine days later. Our loved one was in this facility approximately two weeks. Many of the family members are not aware of the details concerning the medications she was given.
Therefore, they simply saw her decline and was told by staff that it was attributable to her illness. This has been a horrifying experience for me, and I no longer trust a hospice to care for me or another loved one.
I also do not know how to prevent this from happening to others. Most of my family members are completely ignorant of the details of this process and are therefore satisfied with the hospice care. The facility is lovely, clean, and the staff members know just what to say in order to deflect any meaningful questioning. I do not feel that what I witnessed is right. Sorry to hear of your experience, it does indeed sound concerning and very distressing. I also recommend asking to speak to the medical director or someone in a medically supervisory position, if you have concerns about the medications the nurses are administering.
It is very difficult for medical personnel when they get conflicting requests or concerns from different family members. Sorry once again for your loss and for your disappointing experience. This is exactly what happened to my mother in hospice.
She had dementia. She went in on a Friday, and I was assured that she was strong and still had many weeks left. Soon after arriving, the nurses said she had taken a sudden downturn. On Monday afternoon, I was sitting with her when the nurse came in to give her medication. I was told it was Ativan and morphine. She was dead by Tuesday at 5 am. For all intents and purposes, it was euthanasia, and I am sick that I did not realize what was happening right in front of my face.
Euthanasia is a strong accusation, however…that would mean that they gave her medications with the actual intent to cause death.
Frankly, I think that is highly, highly improbable. Also possible that the hospice staff gave her more morphine and lorazepam than was strictly necessary for symptom control…and I suppose possible that this slowed her breathing down excessively.
She may have died sooner than she would have without taking these medications at the doses given, but that is still not euthanasia because it was not the intent of the hospice staff to hasten her death. If you think the actions the hospice staff took were inappropriate, then you may want to report your concerns, I have shared some ways to do in the article. This might help the hospice review its training and procedures. My grandmother was in hospice as well. She was in there prolly going on a week and a half now and she died this a.
How is it that oneday she talking, writing her name, singing and etc and the next day she is just out of it?! It just seems like everytime we left her unattended she was out of it like the gave her morphine or something. The night and days we stay with her she talking and alert but the days we not she sleeping and out of it. She was yrs old. I think the could of gave her less morphine.
I was told they gve her 2 doses of morphine that day and then another 2 doses of it all in the same day. Wayyyyyyyyyyyy to much! I really do believe that was the cause of her death at hospice. She never said she had pain the whole time she was there.
Just shortness of breath and she was bleeding in the inside but some days that would stop and be perfectly fine. Sorry for your recent loss. As I mention in the article, morphine does seem to help many people with shortness of breath, so that may be part of the reason why your grandmother received it while on hospice. Hopefully she was comfortable at the end. Best wishes for your period of grief and mourning. My mother was put in hospice as well with terminal cancer. She was talking and laughing at the hospital before she went in.
As soon as she arrived in hospice she was give Ativan and Morphine. She from then on was in a complete coma for 11 days. I had a nurse have the nerve to tell me I was holding her hand too much, and that I was making her stay here longer. This is my mother! I will hold her hand as long as I want!
They did end up changing her nurse. I know everyone has their own opinions on the subject. Sure, if someone is in need to have these drugs administered then they should be given them. But, I do believe that my mother was given too much and that it sped up the dying process. I even noticed the nurses coming in more frequently to push that morphine button. I wanted to be able to have a conversation with my Mom one last time before she passed and that was taken from me because she was over medicated.
I was there when she took her last breath and was holding her hand. Hard to say whether your mother was given too much medication or not, but certainly sounds like the communication with the hospice team was sub-optimal. Sometimes doctors also prescribe scheduled morphine or other painkillers, especially if a dying person has cancer or some other known painful condition.
I do think she knew you were there and I imagine that was a huge comfort to her. I would rather my mom have a few weeks, days, or even just hours left actually being comfortable, content, pain and panic free rather than months left of feeling like all of the above every single day. Thanks for reminding us to consider how difficult and distressing the experience might be like for a dying older person.
Agree that many people would prefer to be a little drowsy and comfortable, rather than erring the other direction. Of course, the ideal is for everyone to talk to their families about what should be prioritized well ahead of time, through advance care planning conversations. This helps us provide people with what they want for themselves, and not just what their family wants for them.
Though she has been in a nursing home for 15 months, the nursing home started sending her to Er for minor issues of distress. The ER doc suggested it is time for Hospice care and though it is difficult to make those decisions, I agree it is the course my mother would want to take at this point.
She can still swallow but has all other other end stage conditions. I fortunately had several talks with mom about her wishes when the diagnosis of dementia was made and she was clear she never wanted her life extended and did not want to be in pain. That said she does have her moments of clarity which we cling to that show she is not gone yet.
She seems to be in discomfort and pain at times and then will look at you and smile and even laugh a moment later. It makes it very hard to feel certain. I am very concerned she will be over prescribed pain medication but I have also seen her have days without medication when she could not stay awake.
Actually many days as of late. Anyway your article has been helpful to me. Also very glad you and your mother had those conversations years ago. I do think hospice is a good choice for the situation you describe, and hope your hospice experience will be a good one. Nine days ago my father in- law died in hospice care. I experienced the same things others have mentioned in the above comments. My father in-law was in the ICU recovering from spinal surgery, he also suffered from dementia.
He developed MRSA and started to decline. We were told he had 6 months to live and he needed hospice care. In Spain and Portugal they even have to pay for the forms. Information and legislation on morphine varies remarkably from nation to nation, as does the frequency with which it is prescribed. A UN survey published in found that doctors in Denmark hand out an average of daily doses of morphine per million people, while those in Greece prescribe just 30 doses per million.
British doctors distribute an average of daily doses. Michael Zenz of Bergmannsheil University Hospital in Germany published a survey last year showing that between September and August only 2 per cent of terminally ill cancer patients in Germany were given morphine.
British legislation is remarkably liberal compared to the rest of Europe, though few doctors are prepared to take advantage of it. Any doctor can write any patient a prescription for morphine on an ordinary form. A special licence is required only if they are prescribing for addicts. There are fears that the German phobia about narcotics could eventually dominate European practice to the extent that Britain would also have to adopt stronger restrictions on morphine. A working party in the Netherlands is holding talks about harmonising prescribing policy within the European Union.
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How worried should we be about covid spreading among wild animals? Hospice Care Myths and Facts. The answers to these hospice myths are no, no and no. These are the facts:: Hospice is not a place. This could be a private residence, assisted living community or nursing home.
Loved ones and relatives are not kept from participating in caring for the hospice patient. Every patient has an interdisciplinary team that starts with the patient and family: patient, family caregiver, physician, nurse, social worker, chaplain, hospice aid, bereavement specialist, and volunteer. A plan of care is created that family and loved ones carry out at home to the extent they are willing and able. Hospice is not a last resort. When medical treatments can no longer cure a disease, hospice professionals can do many things to control pain, reduce anxiety, offer spiritual and emotional support, and improve quality of life for terminally ill people and their families.
Hospice has no religious affiliation. Hospice provides chaplains and other spiritual counselors from all faiths and no faith.
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