Anyone deal with an overzealous nurse?

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There is a new nurse at mom's SNF. He seems overly interested in getting morphine on board and Xanax and calls me every time mom is struggling. It's a fairly straightforward matter of draining the fluid off her lung and then she's comfortable and can breath. But each time the fluid builds up, instead of getting it drained he talks about her need for morphine. I thought it was just me that found him overly pressuring about it but when my son met him tonite he said he wanted him off my mom's care. Hes very nice but I feel he's either new or possibly a problem..

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The hard part is knowing how long to keep fighting a losing battle. If your mother is content and okay with the continual draining, then it's probably okay to continue with it. But as the neurologist told Rosebush (about a different situation but there are similarities), just because they can doesn't mean that they should.

I think the nurse wants to see the pain controlled and likely feels the continual draining isn't in your mom's best interest. This is neither right nor wrong - it's an opinion that has more than one side. His intentions are good but you may not agree with the approach. Talk with the doctor about how long to keep up the draining.

Consider your mom's wishes. How long does she want to continue this treatment. That should be the main consideration. Some people want everything done and others want to quit fighting and simply control the pain. I hope that she is still able to have input.

Take care of yourself, too, during this tough time.
Carol
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Stressed, is mom on Hospice? Is Hospice on board with getting fluid drained frequently?

We went through this with my mom about a year ago. After her chest had been tapped several times ( including one situation where, as mom's lung reinflated, a pocket of bacteria " bloomed", sending her into septic shock) we sat down with her pulmonologist, who said to me " stop poking holes in your mother. The next time this happens, call in Hospice, get her on morphine and let her down gently".

That is what I'll do.
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Stressed how do you know the plurex is in the wrong place? Have they tried to drain it? It is probably beyond the scope of an SNF to drain a Pleurex. Not really difficult but they often won't take it on.
Your nurse may be new or overly aggressive but he probably knows that once fluid keeps recurring it tends to come back very frequently like daily. Are they giving her strong enough diuretics. I had what is called a pigtail when I was in heart failure for a few days and they drained a great deal of fluid through that. they were going to put in a pleural but said there was too much risk of infection with a permanent drain so they just removed the pigtail and stepped up the Lasix IV which worked pretty well. The nurse wants to give Mom the morphine because it will ease her feeling of breathlessness so she is more comfortable. of course the Zane is for anxiety and everyone is anxious when they can't breath.
If you feel Mom is close to death my decision would be to encourage the morphine and although it won't hasten death will certainly keep her a lot more comfortable. By the way a Pleurex is not difficult to remove and can be done by a Dr in the SNF. Much easier to take out than put in. if you think Mom may have some time left it might be worth replacing the pleurex so the fluid can be drained daily. it is a very simple painless procedure. they just put a vacuum bottle attached to the tube and the fluid runs into that. A lot depends on the reason for the fluid build up and how close to death the family and Drs feel rather than what Mom hopes will happen. Repeated thoracentesis can be distressing and exhausting. Hope this all works out for you. You need to question Mom's Drs and get their honest opinion on Mom's prognosis.
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I know this does not apply to your situation but I just wanted to share.
My mom had a brain bleed near the end of her life. The neurosurgeon at the hospital told us he could fix the problem with surgery. My moms neurologist heard this conversation and pulled me aside and told me he wanted me to think about what he was going to say. He said to me the surgeons could operate but should they? would this operation really better her quality of life? This was a heart wrenching decision to make but the best advice I was ever given. Good luck and God Bless.
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"really struggling" is the phrase they used when my MIL was very close to death. We saw it happening, gasping, kicking, moaning. She could not wake up, we could not feel a pulse. So go there and see it for yourself, it may lead you to OK the roxanol. We did.
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Both my parents would have extreme hallucinations on morphine- so we avoided it. However, towards the end, when my father was on hospice, suffering from CHF and his lungs were filling with fluid, I agreed to morphine as they told me it would help his breathing. Daddy was also given Ativan with the morphine and that seemed to help with the hallucinations- who knows, perhaps he was still having them but with the Ativan he didn't care? I am also sorry you're having to go through this. Seeing a loved one struggle for breath is gut wrenchingly heart breaking.
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Thanks Veronica, for answering, and with your own experience. To answer and update; Everyone was pretty sure the drain was in the wrong place because it was only dripping a little blood (tbsp daily) and not the 1.2 liters of fluid that normally would come out. Also, it was obvious that she couldn't breath due to the fluid building. Today they finally took her to radiology and confirmed that the drain was in the wrong area and she indeed has a large amount of fluid. (The SNF is attached to the hospital here so it's just down the hall) Because a different hospital put the drain in this hospital won't touch it to put it in the right area OR remove it. The nurse made an appt to take her back to the other hospital again and I said No. No more. I don't like the other hospital, they screwed it up already and it's just too much for Mom to go thru that again. Unfortunately, for whatever reason, the radiologist didn't remove the fluid while he had her in there today, don't ask me why, maybe the order wasn't clear, so it's scheduled for tomorrow morning. Her Dr said she can probably remove the drain herself so we planned on her doing that, plus removal of the fluid and some IV meds to deal with high calcium levels. (The Lasix was working but now it's thrown too much off balance) Dr wants to see how she does after thoracentisis and lowering the calcium and that's fine, but we also agreed that the morphine is there if her quality of life doesn't return. SO, then tonight she was so miserable with all that fluid that I asked Hospice for the Morphine. I thought if this is it then let her be comfortable. It was the exact OPPOSITE of what I expected. Who knew? It did not comfort her, did not ease her breathing, did not relax her! She was just as distressed but now it was LOUD. Like an unruly drunk :-/ Well that was a cherry on top huh? Here all this time I've worried about them overmedicating her with the morphine and it turns out to be party drug of choice for my 96 yr old mother! She went from laying in bed with her eyes closed struggling and miserable, to sitting in a chair wide eyed and yelling and miserable still struggling to breath. I asked for some Xanax to get her to sleep. Tomorrow is another day and hopefully the thoracentisis will help, and then we can put together a different strategy for comfort. I'm sure they have other drugs besides morphine. I hope I am able to help someone else with this knowledge that morphine affects some people differently. And I'm super glad I wasn't doing this at home on my own. Now it's time to find out what DOES work when she needs it. Thanks again 😘
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Just wanted to say I'm so sorry things have got so complicated medically. Don't let them fob you off, but don't drive yourself nuts trying to find certainty when in the nature of the situation there may not be any to find. All the same, I hope her team will be able to untangle what's going on and make your mother comfortable.

If the new nurse is young and enthusiastic that's probably what his problem is - youthful enthusiasm and a gung-ho spirit aren't really what you want in hospice. Maybe suggest he be guided by calmer and more experienced older colleagues? If you think he's jumping the gun, don't hesitate to tell him so frankly but not angrily.
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Thank you Pam. I did in fact see my mom really struggle and it did push me. Seeing it and hearing about it are two different things aren't they? Thanks again
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why don't you just take her home and you take care of her since you know best what to do.
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