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Mom has been on hospice for the last 3 weeks for CHF and atrial septal deviation. She is in AL on the memory care floor (dementia). The last week or so she has been having major lower back pain enough that she cries when she lays down and moans in pain. The nursing staff has given her a small dose of morphine occasionally when I ask them to. I have asked the hospice nurse to check mom but she told me she left orders to give mom morphine when she is in pain.
I feel like I want to know what is causing this pain but in the end is it really important? Is it a kidney issue, UTI, or part of her CHF? Should I ask hospice to order tests to find out what it is? Any advice would be appreciated.

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No Garden, nothing intravenously
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Wild guess here, but she's not getting anything intravenously, is she?
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She's still in pain after a course of antibiotics. Her body may be shutting down. Yesterday I went over at 430 and she just woke up from a nap. Walked her down to the dining room for dinner and she said she was cold. Sat down and her whole body was shaking uncontrollably with her teeth chattering. She said she wanted to go back to her room. She walked back fine but kept saying she was cold. We get to her room and she starts shaking again that she was freezing. I gave the caregiver a blanket to warm up in the dryer and put extra blankets on. The floor nurse came in and took temperature and it was 94. Her oxygen was 89. They called the hospice nurse who arrived2 hours later. The nurse gave her morphine and she fell asleep in her clothes and piled with blankets.
This morning the nurse said she came out for breakfast at 8 am and was normal.
Is anyone familiar with what happened?
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The antibiotics aren't working and her back still hurts (at least when she's not on morphine). Still not sure what it could be but at least pain is being managed. I will still keep you updated.
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I had pain in my back some when i had stones . That caused inflammation too ..
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Sounds like your Mom has a kidney infection which, as mentioned by shakingdustoff , may or may not be approved by her advanced directives so you and the hospice nurse need to look at your Mom's advanced directives.

I am glad that your Mom is getting the morphine every 8 hours now. That is the "standard" routine dosage. Is there a PRN order for morphine also to treat any pain experienced in between the scheduled doses every 8 hours?
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Two nurses came by today to check on her. One thinks it could be a kidney stone. Her urine is clear. Have a standing order for morphine to be given 8 hours apart. I’m going to check on her again tomorrow to see if pain is better.
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The dr put her on a course of antibiotics. They aren’t sure if it’s a kidney infection so they are being pro active. Hopefully the back pain will go away.
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Thanks for the update. I hope this new analysis discovers something to identify your mother's back pain as well as treatment or meds that can help for the condition.
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Was glad I was over visiting mom today when the hospice nurse came to check on her. I was surprised to see her on a holiday but she said she was concerned about mom's back pain. She checked her vitals which were all good. She felt around mom's back and mom did flinch when she touched right by the left ribs. The nurse showed me where her kidney would be which was a little lower than where the pain is. She felt her stomach and if there was an aortic aneurysm she would have been able to feel the pulsation. She is meeting with the doctor tomorrow and will run things by him to see what mom needs. At this point the pain is being managed only if she gets morphine so she left orders for a dose in the morning and one before bed.
Mom has been even more tired the last week and the nurse noted some aphasia.
Keep you posted.
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My husband's (at that time undiagnosed) aortic aneurysm gave refered pain in his neck. Who can order the pain meds be scheduled, not prn?
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No she wouldn't pick up anything and has not done anything to wrench her back.
Mom is on hospice bc she was 180 lbs a year ago and now she is down to 90 lbs. and she has a hole in her heart that cannot be fixed. She is on oxygen with CHF, she takes Eliquis, Seroquel, and Namzaric.
I was visiting again today and she is not grimacing in pain when she is sitting in her chair though she says it still hurts. When she lays down that is when she cries out in pain. She used to be able to get up from bed without assistance but now she can barely get herself up. She wants to do it herself but asked me yesterday for help. She is not eating but a few bites at each meal. The nurses aide is giving mom morphine at night but like I said, mom doesn't complain about it during the day (at least to them).
I have been searching the internet for information and one site said that lower left side pain could be related to an aortic aneurysm but it is very rare. Her mother died at age 89 from an aortic aneurysm.
I will keep you all posted.
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Has she by any chance picked up her portable oxygen concentrator? I used to get back strain from picking up and hauling the concentrator to the car. That occurred with both the portable concentrator and the E size tanks.
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Back to the beginning.

Why is mom on Hospice? Which doctor certified and and what life limiting condition does she have?

Your mother is in pain. Pain is supposed to be managed by hospice. She's getting small amounts of morphine at the MC unit that is apparently not enough to relieve her pain.

You need to cal the hospice line and tell them that you cannot leave your mom in pain over the holiday weekend. Someone is going to need to examine her and determine if she needs an ER visit or more pain meds.

Is she also getting meds for anxiety and agitation?
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Yes, I am still here checking in on what you all have suggested.
I did contact the hospice nurse with my concerns and UTI/kidney problem question. She says the pain is in the lower back and not the sides where UTIs normally are. Today when I saw mom she told me it is on her left side below her ribs. I took a look again at her back and nothing is there. No bruising, no red marks, no swelling but if I touch the area she screams out in pain and tells me not to touch her there.
I think I do need to meet with the hospice nurse who comes 2-3 times a week. I have not met her because I work during the day and when I get over to see mom it is just the evening staff who can't answer my questions about how mom was that day. We have texted each other and I expressed my concerns and the hospice nurse said she will be there Monday to check on her. Jeannegibbs I will make an appointment as soon as I can to meet with the hospice nurse and the nursing director per your suggestion. I think we all need to be on the same page with her care. This is a new facility and I think mom is the only one on the floor under hospice. She has a general practitioner who comes to the AL to check on her patients. I am not sure if that doctor or the hospice doctor should be looking into this pain?
Mom is not bedridden and still has her straight posture as she walks. She has to be on oxygen at all times or she can't breathe. She pushes her convertible wheelchair with the tank on the side and then the aides switch her to the concentrator when she is in her room so she is pretty mobile. She was diagnosed with dementia but she remembers many things she is told but just can't think of the words when she talks. She cries and blames us for "dumping" her in this place but she doesn't remember where her home used to be. It is a sad situation.
I will keep you guys posted when I find out what is wrong with her. Thanks.
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I hope this is a stupid question: have you had a look at your mother's back?

Actually - is the OP even still with us?

Assuming s/he will check in again, then: have a good look. You may find a bruise or a pressure sore. If you do, and these are not already recorded in your mother's notes, you may then have a pink fit - but do so with a view to making sure that your mother gets improved monitoring and more comfortable positioning.
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My mother was complaining of bad back pain and I was thinking it could be related to her recurring UTIs. Turned out she had a compression fracture of two vertebrae. She hadn’t fallen or anything, the dr said she could have done it just bending down.
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Is the memory unit of this AL used to caring for people on hospice? I wonder if this is one of their first experiences, because they sure don't seem to understand the protocol.

How often does the hospice nurse visit your mother? You should have a face-to-face talk with her about this. Perhaps you, the hospice nurse, and the director of nursing or the medical manager (or whatever the position is called there) should sit down and come to a clear understanding of who calls the shots.

Does it matter what is causing the pain? Not unless that knowledge is necessary to stopping it.

Mom is enrolled in hospice specifically to minimize pain, anxiety, discomfort, etc. The ALF staff has to be on board with that goal, or it just won't work.
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If mom is in pain, the hospice folks should be giving her enough morphine or whatever other painkiller is prescribed to keep her pain feee. Not just when you ask them to. Talk to the Hospice nurse and or as about why they are not able to keep your dear mom pain free.
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