Please help! Dad in terrible pain.

Baby Bunty

Registered User
Jan 24, 2018
297
0
They should have a care pathway..for end of life drugs ( old liverpool pathway)..speak to nurse in charge..as palliative team should still work weekends..even if they dont any doctor can pxd end off life meds.xxxx
 

70smand

Registered User
Dec 4, 2011
269
0
Essex
So sorry for your worry about your Dad. It sounds like his dose of morphine may need increasing in his syringe driver to ease his discomfort and sometimes it is appropriate to also add some sedation, such as midazolam, which can help someone relax and ease aggitation. Sometimes towards the end of life aggitation can be quite common and it isn’t always easy to determine the cause. The prn (as required) dose may also need to be increased accordingly and given as a ‘top up’, sometimes with a relaxant until he settles. If he is in hospital there is usually a palliative care team of nurses based in the hospital who can advise the staff on the ward what to prescribe. I do hope you your dad is settled and comfortable soon.
 

Toodlepipfornow

Registered User
Oct 27, 2017
45
0
They should have a care pathway..for end of life drugs ( old liverpool pathway)..speak to nurse in charge..as palliative team should still work weekends..even if they dont any doctor can pxd end off life meds.xxxx
Thank you Bunty. It was the weekend hospital palliative care nurse who was reluctant to do anything to ease dad's pain. She just kept saying over and over, "I can't give him anything for another hour and a half. It must be very upsetting for you." It was like she was reading from a manual - no compassion, just a jobsworth.
The palliative care nurse on Thursday and Friday was fantastic, though. xx
 

Toodlepipfornow

Registered User
Oct 27, 2017
45
0
So sorry for your worry about your Dad. It sounds like his dose of morphine may need increasing in his syringe driver to ease his discomfort and sometimes it is appropriate to also add some sedation, such as midazolam, which can help someone relax and ease aggitation. Sometimes towards the end of life aggitation can be quite common and it isn’t always easy to determine the cause. The prn (as required) dose may also need to be increased accordingly and given as a ‘top up’, sometimes with a relaxant until he settles. If he is in hospital there is usually a palliative care team of nurses based in the hospital who can advise the staff on the ward what to prescribe. I do hope you your dad is settled and comfortable soon.
Thanks so much 70smand. Yes, dad is in a hospital but the weekend palliative care nurse has been no help - very reluctant to do anything, despite dad rolling on the bed in agony.
I think the hospital are woefully short staffed and reluctant to be sued by anyone if they up his meds (that what it seems like). I just think it's appalling that he has been left to suffer so much. Thanks again for the info - it's very helpful.
 

70smand

Registered User
Dec 4, 2011
269
0
Essex
The usual limits of how often you can give ‘as required’ medication is generally relaxed when nearing up the end of life. I am surprised and extremely concerned that the palliative nurse was waiting an hour an a half for more pain relief and reluctant to do more. Maybe the on call dr could review your dad and once they’ve assessed him they could prescribe something else, or the dr could contact staff at the hospice for advice. Hospices can give advice over the phone. Thinking of you and hope dad settles soon xx
 

love.dad.but..

Registered User
Jan 16, 2014
4,962
0
Kent
I am so Sorry to read your post Dad was kept mostly pain free in his NH at end of life but although unconscious there were signs from face grimaces that showed pain and drawing up his knees although he had not moved them for a week before becoming unconscious. The nurses were excellent in responding to me and therefore dad and administering another dose even if not 'due'. Everyone responds differently to drugs so one patient may need more or less than another to be effective. Keeping someone pain free and comfortable at end stage is the least that someone deserves. I hope you manage to get someone to see sense and sending you strength you are battling well for your dad
 

Toodlepipfornow

Registered User
Oct 27, 2017
45
0
The usual limits of how often you can give ‘as required’ medication is generally relaxed when nearing up the end of life. I am surprised and extremely concerned that the palliative nurse was waiting an hour an a half for more pain relief and reluctant to do more. Maybe the on call dr could review your dad and once they’ve assessed him they could prescribe something else, or the dr could contact staff at the hospice for advice. Hospices can give advice over the phone. Thinking of you and hope dad settles soon xx

Thanks again, 70smand. Thankfully, on Monday morning when the usual palliative nurse came back on duty, my sister told her what had happened over the weekend and the nurse, and a doctor, spent time talking with my sister to find out exactly what had happened. Since then, they have put dad on pain meds which have kept him asleep and comfortable, for which we are very grateful.
That said, the nurse also inferred that it might not have been pain dad was experiencing. When my sister asked her what else could have been the reason for Dad writhing and shouting in agony, she said, "there could have been a number of other reasons."
Surely the weekend palliative care nurse would have known the difference between extreme pain and "other reasons"?
Anyway, Dad is out of pain now although he appears to be sleeping more deeply today and his colouring is not so good.
Thanks for the reply.
 

Toodlepipfornow

Registered User
Oct 27, 2017
45
0
I am so Sorry to read your post Dad was kept mostly pain free in his NH at end of life but although unconscious there were signs from face grimaces that showed pain and drawing up his knees although he had not moved them for a week before becoming unconscious. The nurses were excellent in responding to me and therefore dad and administering another dose even if not 'due'. Everyone responds differently to drugs so one patient may need more or less than another to be effective. Keeping someone pain free and comfortable at end stage is the least that someone deserves. I hope you manage to get someone to see sense and sending you strength you are battling well for your dad

Thank you, love.dad.but... I'm glad to hear your dad was kept free from pain. It is the most awful thing to know that someone you love is suffering so much. His meds were changed and he has been comfortable now since Monday. Thanks again for the reply.
 

lambchop

Registered User
Nov 18, 2011
112
0
Hi Toodle, It's incredibly hard beyond belief to watch someone suffer and feel powerless to anything - but you and your sister are doing everything possible to try and keep his suffering to a minumum. Thank goodness for you loving and speaking up for your poor dad. So sorry this is even happening to you all. I hope the palliative care team will be able to keep him in a peaceful state.
 

oldman1952

Registered User
Apr 4, 2014
45
0
Thanks again, 70smand. Thankfully, on Monday morning when the usual palliative nurse came back on duty, my sister told her what had happened over the weekend and the nurse, and a doctor, spent time talking with my sister to find out exactly what had happened. Since then, they have put dad on pain meds which have kept him asleep and comfortable, for which we are very grateful.
That said, the nurse also inferred that it might not have been pain dad was experiencing. When my sister asked her what else could have been the reason for Dad writhing and shouting in agony, she said, "there could have been a number of other reasons."
Surely the weekend palliative care nurse would have known the difference between extreme pain and "other reasons"?
Anyway, Dad is out of pain now although he appears to be sleeping more deeply today and his colouring is not so good.
Thanks for the reply.
Hi Toodlepipfornow, I was a nurse for many years and never did I leave any of my patients in pain. During handover I would find out if any patient was on syringe driver or palliative care. This was because I quite often worked as an agency nurse in elderly care. I would go through the medicine cardex and see if these patients had breakthrough pain medication. If not I would contact the duty medical office for that unit and get them written up prn breakthrough medication. Nobody can feel the pain of another person, you can only make a judgement on what you can see at the time or what the other care team has seen. If a person is near to the end stages of life their organs will be slowly shutting down and that is the reason that they are in pain. The heart, kidneys and pancreas are extremely painful when they start to shut down.
I hope that this was just a one off and not happening as a pattern by this nurses immaturity and lack of confidence. Best regards Oldman1952.
 

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