We had yet another substitute Hospice RN, today...
...and I finally received the information I needed about using morphine for air hunger. I get it, now. In fact, this RN (yet another excellent RN; our Hospice company seems to staff only excellent RNs) put it to me like this:

• Chances are, I will never be using morphine on my mother for pain. It is in our kit specifically for air hunger. It can and is used for pain on Hospice, but my mother's profile shows that pain she experiences is better addressed with other analgesics. As well, considering how long she's been harboring her lung cancer with no pain, the likelihood is good that this will continue. Thus, when my mother has pain from the labor required to breathe when her cannula is dislodged, the pain is separate from the air hunger. If the air hunger can be addressed by repositioning the cannula, great. The pain, apparently, in my mother's case, can be addressed with analgesics.
• The kind of air hunger that morphine addresses well is a phenomenon that respiratory patients, especially those who are not going to recover, usually "end up" experiencing on a regular basis. Many patients are on morphine 24/7, the further their disease progresses. The amount of morphine required to address air hunger is quite a bit less than the amount used to address pain. If, for instance, my mother becomes sleepy or has trouble moving after a dose of morphine, I'VE GIVEN HER TOO MUCH. This is important. The RN was very careful to underline that it is typical for respiratory patients who are using morphine to address air hunger not to also appear to be doped up. They should be able, once they're used to it, to go about their regular activities as usual.
• Using morphine for air hunger often allows the patient to use less oxygen. In fact, as I mentioned to the RN, although morphine is supposed to "trick" the CO₂ receptors in the brain into thinking all is well when it isn't, I learned from one of those links on oxygen toxicity that respiratory patients on morphine often actually register better CO₂ levels. The scientific reason for this isn't known; the theory is that when a person's breathing relaxes they breathe more deeply and slowly, thus taking in more oxygen and releasing more CO₂.
• My mother's breaths-per-minute (28 today when the nurse measured them) are at the "upper limit" of acceptability before it's a good idea to start using morphine. So, we're probably within days of using it.
• If I should accidentally give too much on the first dose (in other words, if the recommended first dose is more than she needs) and she becomes drowsy, falls asleep without warning or cannot move with her usual facility, DO NOT GIVE A SECOND DOSE UNTIL THE FIRST DOSE HAS WORN OFF. Then, of course, modify the second dose until we've found the right dose to keep her breathing comfortably and keep her life going as normal.
• Constipation is expected, which can be addressed with stool softeners and/or laxatives. Hospice prefers using ducosate sodium as a stool softener and senna as a laxative. Thr Hospice RN ordered us some of both.

    This is exactly what I needed to know to make an informed decision about when and how to use morphine. I've lost my fear of using it, and I think we'll be able to incorporate it in our routine, when necessary, without problems.
    Why I wasn't able to get this information before, I don't know. Perhaps I didn't know enough to ask for it. Maybe there has been a generalized fear that no one wanted to give me "too much" information. Maybe it was a combination of these. At any rate, I get it, now, and I'm relaxed about the issue; as much as I can be, anyway, before having tried it on Mom.
    I have more information about the contents of the Comfort Pack, and, as well, I'll be establishing a link between this post and the Morphine Manual over at The Dailies. It's time to awaken the Mom from her nap, though, plus a few minutes.
    Later.
- posted by Gail Rae @ 20:39   email  this post