Hello Moo Cow;
In response to your question regarding pain in the hospice patient, as we all are aware, pain can be manifested in many ways. If a patient is non-verbal, restlessness and/or grimiscing would be my first indicator. In the case scenario you describe, maybe the morphine drip was not started for pain specifically....maybe it was initiated for respiratory distress? In hospice, we use morphine to slow the respirations of those with COPD type diseases. Many times there are no indicators of pain, just difficult respirations. It works well!
And, sometimes if we cannot isolate the problem, we do try a little morphine to see if the non-verbal patient responds to the intervention. We usually don't initiate a drip right off the bat, but use small amounts of sub-lingual morphine to see how the patient tolerates the medication and if the distressing symptom disappears.
In this case, I really don't think you "missed" anything. People with end stage disease process can change quickly as I'm sure you are aware. One minute they may be comfortable...the next, they are uncomfortable.
Don't stress over this....I'm just glad they started the morphine for the patient. Rather to error on the side of comfort and a little sedation, rather than not know what is the issue!
Keep the faith Moo Cow!!!
KittieLoverRN in Michigan![]()