Anyone deal with an overzealous nurse?

Oh, and no, no bronchodilator was added :-/

Thanks pamstegma for the support. No, not everyone is able to do it at home. I did it for four years but as I am disabled it became too much when she needed more physical help with bathing, etc. Sometimes people don't think when they rattle off an answer. That's what's good about this site, mostly supportive.
So anyway, after seeing her doctor today when I came out of the SNF and she asked how it was going, I voiced my concerns and questions. When I went in this evening to visit with my mom she was up and coherent! They hadn't dosed her! I can't tell you what a roller coaster ride this feels like. I mentioned the nurse that seems so gung ho w the meds to her Dr, and idk if she said something to the staff or if mom just had a good day but they didn't dose her with the Xanax and she was fine. We went to the cafeteria, in her wheelchair, and had a nice conversation and everything. This is what makes all these decisions so difficult! When I arrive at the SNF and she's unconscious and the nurse is pushing for morphine and Norco and Xanax and telling me how they're trying to make her more comfortable, and then when she's not dosed she's up and okay. She has never, ever complained of pain. I realize she has cancer, and she's 96, and she does get anxious. But it was a relief to know that the idea that she was being overmedicated wasn't all in my head. Thanks for 'listening'

cetude, not everyone can be home 24/7 with the patient. Been there and could not have done it alone.

stressed123, Wow I never saw morphine do that to someone. I'm thinking they gave her a bronchodilator too, which can be a powerful stimulant. So sorry you are going through a rough road with this.

To pamstegma I did say yes to the morphine, probably wrote it in another post, but it was a bad experience. It made her like a wide awake loudmouth drunk. She went from almost unconscious to up in her chair moaning and yelling. It was given through a breathing mask and the nurse said in that form it wouldn't cross the brain network and make her loopy. We both looked at each other when it took effect and I said, 'You sure about that??' We both had to laugh because it was so ridiculous. That was the last laugh I had because they've kept her shut down on Xanax since then. So morphine, or roxanol, may be different for each person, and I'm hoping they have something else to 'comfort' her when she needs it. Keeping someone unconscious when they're not in pain, just anxious, isn't easy to watch. Isn't there a quote somewhere about Dieing is a hard business or something?

Stressed, so feeling for you. ((((Hugs))))

Thank you TooYoung, that was informative. And thank you Churchmouse, for the support. I think you hit the nail on the head. Every single bit of info is relayed second hand from any number of nurses and aides on duty, to the hospice head, and then from her to the Doctor. A little bit of input from me, from others, and you have a mess. I just ran into her Dr on the way out and she was very concerned and said she needed to know my thoughts, not just for me and mom, but to help others who might come along with similar situations. She suggested she, I, and the Hospice head sit down and discuss. Maybe we'll get a plan in order that works.
We all have to remember I think, that family members can be difficult to work with for a variety of reasons, but when you add that they are getting conflicting and confusing input from each nurse on each shift, it can add to the stress dramatically. And when the Dr asked, I realized that by me verbally telling them who helps, and who might be steering the boat off course, it wasn't to get someone in trouble (which was my first thought) it was just to keep a 5 star facility just that. Just always have to be mindful of how we word things. Meaning well and doing well aren't always the same thing.
I'll get thru this, as will Mom. But it sure helps to have this sounding board

stressed, say yes to the roxanol. It makes things less horrible to watch. It is not a lethal dose, just a comfortable one.

What other anti anxiety meds can they try? Klonopin? Can they use a bipap machine?

I'm so sorry, Stressed, for both you and your mother.

Where is her own GP in all this? One person - one medically qualified person, that is - taking ownership of adjusting her px and responsibility for her comfort shouldn't seem too much to ask, is it?

I'm not liking the sound of your nurse any better than I did. As my mother used to say "I'm sure he MEANS well..."

And thank you for the expert advice, I appreciate this. I no longer want to see her get poked (although she says she doesn't feel a thing and enjoys her trip to do it) but I don't want to see her choke to death gasping. They either need to hasten the end with big drugs or drain the fluid. I just want her to go out at peace. Is that not possible?

Thank you all for help, this is truly miserable. The reason I don't take her home is that I am disabled.i can not take her to the potty, bathe her or change a diaper.
One thing I know is this ; you can't pilot a boat from the shore
Mom is at a stellar SNF, but each decision is only as good as the person making it. The overzealous nurse came from radiology and is not young, just I think, very into exploring his new job, and his closest male buddy is a Hospice guy. He is frustrated with me because I don't seem on board with the heavy drugs to comfort Mom.
So she had the fluid removed and she breathes easier. She gets some anxiety and they use Xanax. The Xanax makes her more sedated and vocal. So they give her some more. She is unable to open her eyes or sit up but now she calls out a lot, cries, and says she wants to go home, but can't answer any questions. She can shake her head yes or no when asked if she wants water or is pain. Never in pain. Always a no.
Now I am left with this horrible thing to watch. Either anxious and unable to be calmed without the Xanax, or unconscious and unable to be calmed with the Xanax. WHERE IS THE COMFORT THEY KEEP TALKING ABOUT??
I'm just at the point of screaming. Now they want to add Vicodin. For what? Narcotics wind her up. I think they just need to be clear about their goals! Either help her to the other side or don't, but this no mans land is misery.

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

Yea, the diruetic rx would be to get the edema build up out of body.

Re: the close hospital refusing to remove the incorrectly set drain... I have been in a very similar situation. Medical hardware surgically implanted, was either incorrectly placed, or shifted due to an emergency 12 day hospital stay. The hardware needed to be re-positioned, and I was told I had to go back to the original surgeon. It is a liability issue. Try not to think poorly on a hospital trying to protect themselves.

As a healthcare provider, I think there is a BIG PROBLEM when the hospital won't remove a drain that is not in the correct position to place a new one. It doesn't matter who put the drain in. If she is a resident of the SNF attached to another hospital, it is their duty to take care of her the right way. I would have a major problem with that if it were my loved one. If she is unstable (which it sounds like she is), she is not fit for transfer to another hospital just to have a drain pulled out----especially when there is a hospital right next door!!

Personally, I tend to think that when a person is on hospice, the incentive to treat something is removed because there really is no hope to prolong that person's life. The thinking is that they can just give the person some medications to ease their pain & suffering, and make the road "out" as smooth as possible. Nobody likes to see their loved one having difficulty breathing. In your subsequent posts, you say that your mother is indeed on hospice and 96 years old, routinely draining 1.2 liters of fluid from her chest. Adding that to the equation makes more sense to me for why the hospital is doing what it is doing---your mother is very ill, and a thoracentesis could lead to a hospital admission, which nobody wants to be responsible for primarily due to Medicare rules for reimbursement. The hospital won't get paid for her admission. It is sad, but it's true----admission & re-admission rates are scrutinized by Medicare, and physicians & hospitals don't get paid for them. They don't want to do something, have something go wrong & have to admit a 96 year old woman on hospice that is a SNF resident. So, they figure they'll transfer her to the hospital that misplaced the drain in the first place and let them deal with an admission/re-admission. Have them not get paid for a re-admission of a patient that was previously in their care.

Getting back to the matter at hand----the nurse was probably just trying to make your mother comfortable. And, with orders for morphine & xanax from hospice, that's what he was able to do. Your subsequent posts actually turned into another topic altogether, in which it seems like you are more accepting of your mother's passing rather than torturing her with more thoracenteses, drains, etc.

Stressed I hope by now Mom's situation has changed and she has a properly placed tube that can be drained regularly. Placing a tube is not too stressful and does bring a lot of comfort so I would not be against the proceedure as it is certainly a comfort measure.
As far as the medications are concerned the side effects of many drugs are totally unpredicable especially in the elderly so it is often necessary to experiment to find what works best.
I hope the Dr that said the tube could be removed meant herself not Mom. it would be dangerous to do that ones self. It is a simple process but should be done with safeguards in place in case it is actually in the lung rather than the two layers of pleura surrounding the lung. Reinsertion has to be done under expert X-ray control so the radiologist can see exactly where it is being placed and there is sufficient fluid in the pleura for the two layers to be separated enough to safely introduce the tube. It is possible that the closest hospital does not have the necessary equipment or trained staff to do the procedure. What you have heard is a refusal to do it but they may mean they can't do it because they lack the equipment and expertise. When you are so stressed it is often confusing to really hear what you are being told especially if it is conveyed through a third party.

I agree that it's worth asking about her diuretic px and whether it can be adjusted. But I also wouldn't be too hopeful: if the dose hasn't already been adjusted to clear the excess fluid there will probably be strong medical reasons for that - such as that her kidneys can't cope. Still, no harm in asking.

that drug increases urination; draining excess fluid out of the body.

Is she on Furosemide/Lasix? That drug increases urinat

When my sister-in-law was losing her battle with metastic cancer some years ago, her daughter called my husband and their sister (we live some distance away)and told them they needed to come as her mom had fluid on the lungs and they were refusing to drain the fluid and wanting to give her morphine, which they said would not only make her comfortable but depress her breathing and....
My SIL went and convinced the doctors to drain the fluid and hold the morphine--she lived several more months in relative comfort.

Hello, I can feel how worried and stressed and concerned you are for your mom. I am sorry you feel you can't trust this nurse because it makes a difficult situation so much worse. I will share with you that I am a nurse practitioner and in a case where a patient is struggling to breathe due to excess lung fluid it is classic protocol to use Lasix (a diuretic) and morphine. The Lasix helps the body get rid of the fluid via the kidneys and morphine dilates the blood vessels in the lungs which assists in this process and also decreases anxiety due to breathlessness (usually). I don't believe this nurse is doing anything but trying to help your mom at a critical point when she is in need of quick relief. Your mother obviously experiences an idiosyncratic reaction to morphine when she is given that drug and may need a benzodiazepime (antianxiety agent) in addition to the morphine to help keep her from becoming agitated. My best to you and I hope your mom gets some relief.

i think the most important thing for your mom is that she is not in pain. i would do everything in my power to make sure she's not suffering silently.

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.

why don't you just take her home and you take care of her since you know best what to do.

Aside form the very stressful medical situation your mother is experiencing, I too feel that another nurse should be caring for your mother. No one is a " standard" when it comes to end of life. You both need the caring, respect and experience of a more seasoned nurse. Her physician should change the med ( morphine ) if it is not having desired effect and you should speak with the nursing supervisor or director of Nursing to have another hands on caregiver.
The supervisor of Nursing should also observe this over zealous nurse to see what he is doing both with and away from patients.

Hi, stressed.. I hope today's procedure goes well - it seems horrible that this hospital will not remove the incorrectly placed one - what if she came in during an emergency, would they refuse to treat, because something had been done elsewhere?? But it sounds as if you've said, she can remove it herself (I hate those legal ass-preserving distinctions) - but if that's the case, maybe you can get the better placement started, and work to find ways to make sure that the self-removal option is carefully attended, to minimize any risk of infection.

I'm an oddball, but I believe we can rush in fear to adding drugs - one cannot wait forever, but surely one can see through the next procedure, when it sounds as if it may correct an error - and comfort by companionship and minimal sedation and pain meds, keep telling your mom that this next intervention will make things better, whether she looks as if she can hear or not - pray and trust and help her hope through this attempt to rectify, and revisit the issue of drugs another time. Sometimes the drugs can ease anxiety and mask symptoms.

I know how challenging all these choices, conversations can be, when the risks seem so high. I saw morphine help a lady with a severe cancer, and had to be somewhat convinced - yet I've also seen times when compassionate extra company, hand holding, resting together, can help an elder calm down, and if you have the alternative procedure planned, this seems good to try, for when things turn around, small signals grow into recovery, and that's amazing too.

You need to be suspicious! Any care giver who suggests narcotics or any strong drugs that have street value is probably an addict or a pusher. I would report it anonymously to the director of nursing.

You need to report him immediately!

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.