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Ok. The nurse and/or prescriber apparently want your mom in the twilight zone and you don't. Request a meeting about her meds and her goals. People metabolize meds differently and maybe something she is taking is accumulating and keeping her out of it. I just had a second case of slow metabolism of clonidine iwth prolonged sedation, FWIW, with one of my outpatient. You might need to order changed or the dose changed, or to have it specified that the "PRN" is only for severe distress, or even that you want called to talk to her first to see if you can calm her first.

I say apparently because the next two questions are harder - is it possible she is in pain or distress if she is less sedated? is it possible she is out of it because of her undelying medical condition? They should be able to answer that for you.
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The nurse can only give what the Rx says to give. They have no choice. Suggest you take this up with the MD who wrote the orders.
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stressed, she is going to sleep more and more. You can ask the MD for a blood draw to check medication levels, but sleepiness is not necessarily overmedicating. It can very well be the body shutting down.
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The other thing that occurs to me is that you can cancel Hospice and ask that she be admitted to the hospital (they're in the same building, yes?). Just thinking out loud here.
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Stressed you can call hospice anytime day or night, there is always a RN on call. You can request an immediate visit and he/she can contact a Dr and get the orders changed. There are many pain meds available and can be immediately changed, same does for the anxieolitics. This is not to say that what ever is done will change your Mom's condition but at least you will have done your best. You can certainly have her taken to the hospital but that does not guarantee a different outcome. I think you sound as though you are at least halfway to accepting that your beloved Mom is close to the end. Let her rest in peace for her final days. Waking her up at this point will only increase her suffering. Experienced caregivers know that this scenario is common at the end of life and these changes do occur very suddenly. Many caregivers beg for the nurses to give their loved ones enough medication to just allow them to sleep till they pass. You have been challenged by the way Mom's end of life is playing out.. I can not say you are wrong and she may simply have reacted negatively to the medications used and the temptation is always to increase the dose.
When a patient is in a facility the staff there assume responsibility for the majority of that patient's care so it is not unusual for hospice nurses to only visit a few times a week. however as I mentioned you can request a visit at anytime this is just as important for the support you badly need as for your loved one. The lines of responsibility get very blurred when a hospice patient is in a facility which is not run by hospice. The staff are not specifically trained in hospice care so they can only apply basic nursing standards.
Stressed your reactions are not wrong, your Mom's care may have been mismanaged due to many reasons and you are rightly upset by what you are seeing. Everyone would like to see their loved one pass away peacefully in their sleep. Unfortunately this rarely happens which may or may not be anyone's fault.
Was the nurse over aggressive with her use of the medication? No one has the answer to that although some people held that opinion but from experience I can tell you that patients often require huge doses of drugs in their last few days and are very grateful that the nurses are not afraid to use the doses the Dr has ordered and never hesitate to request an increase.
Try and find peace with the last few days of your mothers' life. Blessings
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Pam, if I recall, Stressed's mom is on Hospice and she feels one of the Hospice RNs is being over-zealous with morphine.
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The Xanax says, As Needed, 1/2 tablet 2X a day
I haven't been able to talk to my Mom for 2 days because she's unconscious every time I go there to visit. (3 x a day) Today I arrived and she was on her bed pretty out of it, eyes closed, but still conscious. At the same time I got to the room the nurse came in with a spoonful of chocolate pudding in a medicine cup. I asked what that was for and she leaned over Mom and said open up and put it in her mouth before answering me. She said she 'chewed and spit the other out'. If that was the case why was my Mom already drugged from the one she 'spit out'?
I've been told that nurse is heavy handed with the meds but I don't repeat something unless I've seen it myself.
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In general, I would agree with Pam. It's the fact that your mom's doctor asked you to report anything fishy that makes me say to call her.

Yes, her body may be ahutting down. But talk to the doctor.
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Stressed I know this won't be helpful at this terrible time but 3 days without food will not make someone a skeleton, it takes many weeks for that to happen.
I can't comment on whether the nurse is being heavy handed with the drugs or simply easing your mother's passage from this world to the next.
As Vstefens says the nurse can only administer the drugs as ordered.
Watching a loved one get to this state is very very hard to accept under any circumstances and with your current feelings even more difficult. They certainly can reduce the amount of medication and your mother may or may to wake up and you may not be happy with her condition if she has actually entered the dying stage which nothing can reverse.
To others always question what is being done/given to our loved one whether you have personally seen it or not, There is often another explanation than the one you have been led to believe.
Stressed you are probably feeling angry and afraid right now because you feel you are being robbed of this final time with your mother and feel there are still things to communicate.
Try and just sit with her , hold her hand and tak quietly to her, let her know it is alright for her to pass if the time is right. If you are spiritually inclined read the bible to her or just talk of ordinary things. the last thing she needs right now is to hear the anger and frustration in your voice. If this is allowed light a candle by her bed with a calming scent such as lavender or her favorite or sprinkle a little on her sheets or just wear it your self. Music often helps too.
Lastly do not accept the overmedication if you truly believe that is happening. Doses can always be reduced, but you may find the agitation is part of the dying process and the only answer is sedation. If you are Mom's POA you have the right to refuse medication on her behalf.
Severe agitation is very common close to death and you can either let it continue or use sedation.
As far as feeding is concerned, it can be tried a small soon at a time but be prepared for her to choke on it. Ice chips to keep her mouth moist may be helpful.
I am so sorry you are experiencing what you see as mismanagement in the turmoil of your grief but be comforted that your mother is not suffering.
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Dear Stressed, there are antipsychotic medications but they tend to turn a person into a "zombie". Haldol and Respidol are 2 of them. Very powerful drugs. I'm not sure you would like the effects on your mom since you didn't like the effects of Xanax.
I agree with Vero, everything she suggested is right on. It can be very difficult to watch the different stages of passing. Each person has their own way of leaving this world but most tend to get very anxious and benefit from some sort of calming medication. Does it seem that your mom has any pain? Maybe they could use pain meds to calm her instead of benzodiazepines. There are many to choose from.
You have a few choices;
1. Move her to a different hospice (farther from your home).
2. Have her admitted to the hospital (that cancels hospice services).
3. "Find" some money (sell or pawn items, take a loan, etc.) to bring her home and hire home health aids for 2 shifts.
4. Demand (yes, demand) a meeting with a the hospice director, her nurses and her private doctor with you. Have ready the exact way you want her medicated. If they can't do it, send her to another facility.
It's disturbing that both her private MD and the anonymous worker in the hospice made reference to "fishy" happenings and "controlling" patients with nurse Ratchet
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