Just to let you know...
...ai, yi, yi! Yesterday went well with the morphine; it seemed as though Hospice and I had gotten the titration right for Mom. Today, all pain and air hunger hell broke loose and it took from noon to about 1645 to address them successfully, which included:

• A total of 1.0 mL morphine over a four hour period;
• 500 mg acetaminophen to stop it, another 500, about 15 minutes ago, to keep on top of it;
• Several, I'm not sure how many, calls to Hospice to get an okay for each dose, until I was finally told I could give her .25 mL per hour without calling Hospice until the pain and air hunger disappeared, for awhile any;
• A visit from the non-emergent paramedics to pick her up off the floor and put her back in bed. That's right, folks, at one point her pain was so bad she was doubled over and even though I was holding her on the bed with my arms and my body, the force of the pain and her doubling slid her off the bed. I made her as comfortable on the floor as possible with one of our handy-dandy wedged...her pain stopped within about 15 minutes, I covered her with a blanket, the Hospice nurse showed up, examined her, then the paramedics were called;
• I am keeping a close vigil on her now, of course. She has had nothing to eat, little to drink, has been out of it all day, cannot hold herself up in a sitting position without great difficulty which indicates she is incredibly weak, right now, but her speech is good, her lungs sounded surprisingly clear to the nurse, her blood pressure was good (120/70), her breaths per minute remain good at of 1815(20), two hours after her last dose of morphine but, of course, I'll be checking them assiduously in order to try to get her next dose in just before she needs it;
• I kind of, sort of, expect that the night will continue much like today so I'll be dragging my bedding into her room to sleep with her tonight;
• I have no idea what lays in store for us at this point.

    She is, of course, very drowsy, dehydrated, she's been changed and cleaned (while the nurse was here, bless her heart, she offered to help me do this for Mom while she remained in bed; I did not refuse her offer); she's had nothing to speak of to eat; she is not "drinking well with others" even through a straw, although she did take the last dose of acetaminophen (at 1815) crushed in cherry jam (one of her favorites), swallowed it well and drank a little water.
    I'm going to try to hold off until at least 1915 for her next dose of morphine but, well, we'll see. I'm hoping I can get her on a fairly steady regimen throughout the night of acetaminophen every four hours and morphine every three to four hours.
    In the meantime, I won't be updating the companion journals. I think the one over at The Dailies is due to publish at 2359 tonight but it will be fields with question marks and, I think, one entry in the Medication Changes section. Otherwise, well, you know what I'll be doing.
    Not sure when I'll update this again. Not sure, really, where we are with all this, yet.
    Whew! Amazing!
    I think I'll go check on the Mom.
    Later.
- posted by Gail Rae @ 18:24   email  this post