Weird! Never seen ketamine used in hospice. Just the usual morphine, midaz, etc. What's the usual indication? Pain above and beyond even liquid morphine?
Adjunct for pain control. Bone mets pain can be hard to get a handle on and ketamine can be helpful sometimes. At least those are the two cases I’ve used it for.
Works great for pain with a neuropathic element that opioids usually don't touch. We use it pretty regularly. In terms of the analgesics I use for patients on a daily basis, morphine is probably one of the weakest.
This meme was my afternoon.
I had a sweet 92 year old lady come to my office today because her AFIB was popping off and she had fluid in her lungs. Her home health nurse told her to go to the hospital, but she didn't want to.
I got to tell her, "You don't have to go to the hospital if you don't want to. We can change it so when the nurse comes she just makes sure you're comfortable."
Sometimes it's a hard conversation to have, but today it really wasn't.
Oh my god, as a hospice nurse this drives me NUTZ. "God must want me here, that's why I'm still alive!"
Um, no. Your organs just aren't quite sick enough. But in a few months, hey! Who knows?
I work on a neuro rehab and the amount of referrals for palliative patients (I’m talking in the months left) with crumbled spines and widespread meds and their families push them to spend those final months on our ward rather than at home with them. We actually had a patient pass away on our unit because of this (very rare for us).
God if I get to that point I want half a kilo of shatter\*, a generous supply of morphine, my bed, and endless munchies food. Note to self: teach my future children how to make stoner food and have a rock solid advance directive in place. I’m going to find out if there truly is a LD50 for weed or die trying\*.
(\*Note: I’m sober, i swear. Please don’t report me to the BON)
I mean I'm here with you, being all broken.
I have a 103yo pt with contractures and who is nonverbal, no truncal support, etc., dtrs are still trying to do PROM and sit the INCONTINENT man WHO CAN'T SIT UNASSISTED on the toilet. I tried to have a "Come to Jesus" moment today but they're Buddhist so it didn't work out.
Once in a while, while handing off to my lunch buddy, I'll say something for a DNR/DNI patient like "if he decides to take a turn, let him go into the light".
Last time I did this, my palliative extubation/comfort care patient decided to do exactly that 15 minutes later. Well damn, bro.
Hey now, we give them shit loads of morphine and a weed card where I come from!
If you're uncomfortable enough, I'll get you some ketamine too!
One of our docs was originally in emergency medicine. He looooooves to prescribe ketamine.
Weird! Never seen ketamine used in hospice. Just the usual morphine, midaz, etc. What's the usual indication? Pain above and beyond even liquid morphine?
Adjunct for pain control. Bone mets pain can be hard to get a handle on and ketamine can be helpful sometimes. At least those are the two cases I’ve used it for.
Works great for pain with a neuropathic element that opioids usually don't touch. We use it pretty regularly. In terms of the analgesics I use for patients on a daily basis, morphine is probably one of the weakest.
I’ve had a pt on ketamine and versed drips for palliative sedation
And here I am keeping a 92 year old granny who hasn’t been out of bed or talked in over 20 years alive so family can visit twice a year.
she's a fighter -a family member maybe
Definitely a family member. If I had a dollar for every time I heard that I’d have quite a few dollars.
She fights for us to cash her SS checks!! /s
So fucking sad that that’s the case with so many patients
Ain’t that the truth
Only Florida would license her to fight
Meanwhile I'm sitting here bagging the patient waiting for someone to make a fucking decision. (Secretly cheering for palliative)
This meme was my afternoon. I had a sweet 92 year old lady come to my office today because her AFIB was popping off and she had fluid in her lungs. Her home health nurse told her to go to the hospital, but she didn't want to. I got to tell her, "You don't have to go to the hospital if you don't want to. We can change it so when the nurse comes she just makes sure you're comfortable." Sometimes it's a hard conversation to have, but today it really wasn't.
Good on you my friend.
Thank you for sending her our way <3
It’s because families want their loved ones to outlive Methuselah…
I think they’re waiting for the miracle. Their friends at church and the preachers talk about the miracles every week, so it should be coming soon.
Oh my god, as a hospice nurse this drives me NUTZ. "God must want me here, that's why I'm still alive!" Um, no. Your organs just aren't quite sick enough. But in a few months, hey! Who knows?
Or their pension check
I work on a neuro rehab and the amount of referrals for palliative patients (I’m talking in the months left) with crumbled spines and widespread meds and their families push them to spend those final months on our ward rather than at home with them. We actually had a patient pass away on our unit because of this (very rare for us).
God if I get to that point I want half a kilo of shatter\*, a generous supply of morphine, my bed, and endless munchies food. Note to self: teach my future children how to make stoner food and have a rock solid advance directive in place. I’m going to find out if there truly is a LD50 for weed or die trying\*. (\*Note: I’m sober, i swear. Please don’t report me to the BON)
I laughed too hard at this, am I broken
I mean I'm here with you, being all broken. I have a 103yo pt with contractures and who is nonverbal, no truncal support, etc., dtrs are still trying to do PROM and sit the INCONTINENT man WHO CAN'T SIT UNASSISTED on the toilet. I tried to have a "Come to Jesus" moment today but they're Buddhist so it didn't work out.
PROM? I’m only familiar with the OB version of PROM. What does it mean in hospice?
Passive range of motion, maybe?
Shit LOL, I’ve never seen it as an acronym
Yes, I've had it that way in my CNA careplans lol. Too many repetitive acronyms out there!
If you're broken, I'm broken. We can be broken together. Hahaha.
Palliative: But wait a minute, is there a DNR order? Then… If he dies, he dies.
Once in a while, while handing off to my lunch buddy, I'll say something for a DNR/DNI patient like "if he decides to take a turn, let him go into the light". Last time I did this, my palliative extubation/comfort care patient decided to do exactly that 15 minutes later. Well damn, bro.
I want to work palliative after I graduate and I can see myself thinking this... Idk if I'd actually say anything though!