My husband has multiple system atrophy and has been on in-home hospice since May 2023. We were given a comfort pack the day we were put on hospice and have had to use many of the items. Hospice has been so good for both of us. The hospice nurse, social worker, and other team members have been fantastic. A big shout out to all hospice workers. You help make the end of life better for our loved ones❤❤❤❤!
My prayers are with you. My husband also has MSA and is currently edging towards his final days. Hospice nurses are awesome. These meds are helping him so much but also helps me to see him in less pain and agitation. These videos have answered so many questions.
Thank you so much for this informative video. I am 85 & of course death looms nearer, I have CLL & hope to benefit with hospice care when my time comes, thanks to the fantastic carers and nurses who have such compassion for their patients❤
My mother passed at 94 y.o. on 8/29/23. Yes, my mother was on a few meds stated in the video. Truly is a misconception that morphone delays or quickens death. Lorazepam was used for the last 4 weeks and morphine 5 days prior to her passing. She died peacefully, and as they say, you die as you live. My mother was at peace in life and had a deep faith all her days so she was fairly easy (my mother wasn't very verbal). She was on hospice 6 weeks at home. Rest in peace mom, you are missed and loved by many! She was from a generation of 'tough' lineage. You think you're prepared but losing your mother is a void! I am a part of her! *tears 🥲
I’m so sorry your mother has passed, the void in our lives without our mother is a pain that doesn’t really go away. My mom was from that “ tough generation” they lived through some very hard times, yet they gave us the example of how to carry on with our life. My mom has been gone for 20 years but I think of her every day. She was a small lady but had the fortitude of a giant. Alzheimer’s took her from us. It was hard to watch her decline.
My thoughts, having gone thru this twice with my parents, & currents with my brother: Morphine- keep giving it right to the very end because you don't know if they are in pain or not. Also, air hunger brings with it a great deal of anxiety. 2. Lorazepam- Dying can be scary stuff. Anything to help lower that anxiety is a blessing. 3. Haldol- Also helps with agitation & anxiety. Atripine is more for the people caring for someone at the end of life. You don't get that sound out if your head, & it can get VERY loud. It's also the sound that sticks with you. Those drops under the tongue are a blessing.
@sharonparker5277 NO! Caregivers should administer the Atripine to the patient, because listening to the often very loud noise is heart-rending & traumatic. By the time tge death rattle comes, the patient is no longer aware.
Thanks for this information. I am sorry you have had to go through this several times but it is very useful information and I appreciate you posting. As someone with a terminal illness I find this sort of information very comforting. Just a comment with the death rattle, my understanding is that this does not affect the dying person themself, but it sounds like this is a difficult thing for loved ones to witness.
My grandma had that misconception when my dad passed on hospice, even after my grandpa had been on hospice 20 yrs ago. Her husband was bedbound for weeks, then had pill morphine before getting it delivered by nebulizer. My dad, who had gone on hospice a week before, was ready. He had made peace with everyone, had talks, etc. He just needed that ativan for nerves, because he was afraid he remembered watching his dad die from the same thing. And he was on just enough morphine to relieve his pain, so he could be comfortable eat. And this helped him BE AT PEACE. And it helped him to do what he wad ready to do, let go.
Thank you for explaining end of life medication uses for the patient AND caregiver. I remember my parent's last air breath and it's been 7 & 8 years ago.
I've been cleaning house for my 88 year old neighbor and she was just fine until 4 or 5 weeks ago she started having a bloated stomach and having an even harder time breathing due to emphysema or what they now call COPD. I'm just in shock still of how fast this came on. She is now home in hospice care. Her husband I'm the most worried about. They have been together for 48 years. I'm not sure what to say or do to help this wonderful man and his beautiful wife but i know i will be there till the end....no matter how hard it gets for me it is 100 × harder for him. God bless all of you care givers.
With my mom, Lorazepam/Ativan triggered an increase of hallucinations. We had to talk with the nurse and doctor to adjust her medications to settle her down. Don't be afraid to talk with the hospice nurse and the doctor should anything change. Thank you for your excellent videos.
Same with my grandma that I’m going through right now with her, we got them to switch to Xanax, and she’s a LOT more peaceful. The hospice nurse tried arguing with me saying they are the same thing and I had to explain to her they are indeed not the same thing. Were hit and miss with hospice nurses
@@gregorymalchuk272 Xanax, my grandma passed while on hospice on 7/9 unfortunately. Raised me by herself since birth. At the end she was on 1mg Xanax every 3 hours, along with Haldol every 3, Dilaudid every 4, two fentanyl patches 50mics each, so be careful and only reserve for extreme sundowners. She was an EXTREME sundowner. Put that was easily enough meds to kill her so I held some of her last nights dose and she slept through the night, I knew if I gave it to her, that would be it. I could just see it in her breathing. So we dealt with it at around 4 am, but she slept most of the night which was unheard of until the Xanax. Ativan is not a good drug for this (I’ve been on benzos my entire life just about, trust me on this), you need Xanax for the sundowners if Ativan is not having a good enough effect. I have her the last 1mg of Xanax and 3mg Haldol, and a few hours later me and my aunt were talking with my aunt with her back to my grandma, and I noticed she went from breathing super shallow and frequently the night before to BIG DEEP breaths very spaced out and I said “this is it” and we went over and each held one of her hands, there was like 4 of us, and it wasn’t probably 2 more breaths if that and that was it. I miss her every day. But MAKE those fucking hospice doctors do what is NEEDED. Not what the “book says” or what they want. I wish you the best in these terrible circumstances. Just call hospice and tell them, not ask, tell them that SOMETHING STRONGER IS NEEDE if they are still suffering. Pulling at their clothes and bedding is common, yelling is common. My grandma was constantly yelling “oh god, please help me” all night. It was absolutely brutal. The Xanax was the only drug that helped. You need a strong benzo and haldol, and make sure they aren’t feeling a thing. That’s it. If a hospice nurse tries to argue and say “well Xanax is more potent than Ativan and blah blah”. Remind them, SO FUCKING WHAT? They’re dying. I had to get loud with the hospice doctor, but sure enough the Xanax and Dilaudid were called in that morning. So do what you have to do, and fight them on it if you have to. That “emergency care kit” is mostly garbage that won’t help a large percentage of people. Particularly the Ativan. Again, we have Xanax for a reason, so do what you need to do. Good luck, you’re not alone.
I have been watching your posts for months preparing for the passing of my 103 year old father. You really helped me prepare and help some other family members as the end of life secretions started 8 days ago. Dad passed away quietly on Wednesday evening. We had to not use the word hospice around him as he believed that was a process to end your life rather than ease your life end. Thanks so much for helping me to prepare (you never really can).
Thank you Nurse Julie. I'm trying to understand these medications for use for myself when I need to go into hospice care. (Hopefully a long while from now) I'm most concerned with shortness of breath, pain, and panic attacks. I've heard horror stories about people at the end of life with lung diseases and how some were "gasping for breath". I have stage 3 COPD and want to have my family ready for any medication I may need. Ty again for an informative video. Love ❤ from Ohio
I’m not a doctor, but I do know about hospice and a hell of a lot about meds. My whole family is either doctors or RN’s. They will start you on morphine and Ativan at first most likely. My grandma has COPD, cancer, lungs working at 20%, cellulitis, diabetes, CHF, you name a thing, she has it, and she’s in hospice right now. If the Ativan doesn’t work and your caretakers see you’re still agitated, tell them in advanced to push for Xanax, this did WONDERS for my grandma. People think all benzos are the same when they are no where close. She has the worst anxiety naturally before all this of anyone I know besides myself (I’m on Xanax 3x daily). The morphine wasn’t enough for the pain so we upped to Hydromorphone (Dilaudid…about 10 times stronger than morphine). Then when that didn’t cut it we upped her to fentanyl patch (about 100 times stronger than morphine). Then when that wasn’t enough we upped her to two fentanyl patches. So she doesn’t feel a thing, she’s getting Xanax and Haldol at the same time, so she is as calm as you can possibly be. We all talked with her one by one before we have her the heavy stuff. But she’s still powering through all of that, which would be enough to knock out a lumberjack for 3 days. My grandma is a strong ass woman, she raised me (grandson) and many many other kids that weren’t her own. And she taught us well and brought us up well. I lived with her from birth until I moved out with my wife and still saw her at minimum once a week. I’d stay at her house before she had to be hospitalized for days on end and talk with her. But long story short, you’ll be comfortable. Just have that conversation early with your family and make damn sure they stay on the hospice nurses ass. Some are amazing and caring, some it’s just a paycheck to them. So sometimes you do have to fight them to get the meds you need. You know your family way better than some nurse that just met her 5 mins ago. But don’t worry about panic attacks, that will be completely controlled. You’ll be completely out of pain and dreaming about whatever your favorite things are.
Hi Joy don't u think that the nurses will determine what medications you might need at that stage...depending on your specific situation? Your family won't be able to order any medication either. The aim of hospice is to make patients comfortable. They'll take good care of you ❤
My dad died on hospice this year and I was the one to give him the final dose(s) of morphine. While rationally I know it only helped ease his suffering, and did not 'kill' him, sometimes bad thoughts creep in. It is so comforting to hear your words and explanations. Thank you, Nurse Julie.
My mother in law was in hospice care before she passed. She was diagnosed with stage 4 lung cancer less than 6 weeks prior to her death. She was very frightened of pain and asked us to make sure she didn’t die in pain. Our wonderful hospice nurse made sure she was given sufficient morphine to diminish her pain. My mother passed in a hospice care center and I can’t say enough good things about her care there before she passed.
My Dad died last year. He had his first visit on a Friday and the following Monday night, things went terribly downhill. The only call hospice nurse was called two times. Each time she came to see him, writhing in horrific pain, she said she she could not give him anything for pain because the nurse who had been assigned to his case had forgotten to submit the order to the physician for approval. The sweetest man on earth, suffered horribly and needlessly until his death the next morning. Losing my Dad in this way, knowing how he suffered, has destroyed me.
You should complain to whoever because this should not happen This is pure neglect we all want to leave this world without pain and now there’s no need to how disgraceful Sorry you had to witness this poor professional behaviour.
They are dying…. they should be given whatever they ask for. Who cares at that point? It’s totally ridiculous if that man had to suffer that way. I’m asking for the Morphine the first day of Hospice care 😑
@@ITSMEBETTY50the worse part is that in the hospital if there is no family, they will give them Haldol and fentanyl and knock them out, it’s called a “sleep till the next shift dose”. Or they will give a “nurses dose” which is a real thing, where if they are truly suffering in agony and nothing else will work, they will hit them with just a smidge too much morphine
My mother was on a morphine drip. She had a tube implanted into her chest that then connected to a black bag that had a pump inside of it. It measured out a certain amount 24/7 then there was a little handheld thing where she could push a button and it would give a boost. That boost could only be given every 10 minutes (or 15, I can't remember as this was back in 1999) otherwise she wasn't given anything. She had pancreatic cancer, cancer in the lower lobe of her right lung and cancer in her liver. The hospice nurses were the ones that refilled the morphine pump.
I'm so sorry about your mother. I also had that same experience my mom also had pancreatic cancer and given morphine. I just hate that its so painful and nothing i could do for her but beg for more pain meds that would keep her out of pain 😢 I hate that for anyone that knows how painful it is to go through that kind of cancer. That was almost 20 years ago
@@lubans369 I am sorry you know what that's like, too. Big hugs from me to you. The worse part is when the tube that delivered the morphine somehow got a hole in it. It was leaking down her side under her shirt and she didn't notice until suddenly she was in such severe pain that she was begging me to kill her. Luckily there was still a bottle of Dilaudid leftover from before they put the tube in and I was able to give her a couple of those to hold her over as she was rushed to the hospital to get a new tube inserted. I still get nightmares from that night with her crying and begging me to kill her.😭
@@dora_the_explorer975 thank you. I am actually grateful that I stayed with her in her home until she died. It allowed her and I time to be together and to say goodbye. It was very hard but I would do it all over again if I could.❤️
Nice to hear how patients are cared for in a hospice setting. In the hospital we usually put patients on Morphine, Ativan and sometimes Dilaudid and Fentanyl drips , use Robinul IV to dry up secretions as well as Atropine drops. The Dulcolax suppository is the most underutilized drug in my opinion.
We were told in nursing school, and in clinical settings, that morphine can hasten death BUT as long as the intention was to relieve suffering, then it’s ok. Although it can appear as if death is being hastened, it’s actually the disease process taking over, in the absence of conflicting symptoms.🙏🏻
@@arribaficationwineho32 I’m disappointed that this happens. The end of their life is inevitable, the patient is not going to get up and have a coffee and chat with them, they are headed toward permanent sleep. These people don’t seem to be coping with reality in the best way and I think nurses are familiar with it. Hospice staff are angels on earth.
My mother has been on hospice a few months now. She is not getting much relief from the Norco so they have put her on Morphine. My sister and I were so scared of this but my mom is so much more comfortable now with it. Thank you for this video. It was very reassuring.
Thankyou Nurse Julie. I admire you for getting g this stuff out there and educating people. Another thing is fluids. Many people think dying people must have fluids. As you know, the body is preparing to pass, giving fluids only puts pressure on the organs. Thankyou for all you do 🙏🙏🙏🙏
I am a pharmacist and see a lot of these packs , I often think about who it’s going to and send love.I often wonder about giving benzodiazepines but my friend had great fear of dentists and was given some midozalam , she felt as if she had no care about what happened,So I suppose it may be a great help.I often wonder about my end.I want to be conscious as I am a believer in continuation. It’s a real dilemma because none of us knows how we will die.I have sat with dying who had no one but the one I am thinking of was already out of it and I left him in peace to go after giving him the Buddhist sutra reading he asked for before I got there He died not long after I left and I swear he smiled while I was reading. Great work you are doing.
Thank you for your comments about how morphine works to comfort in dying, not to hasten death. My mother died in a hospital, having been admitted for respiratory failure. She was given a liquid morphine under the tongue. A nurse friend called it Roxanol and explained to me how it kept my mother from feeling like she was suffocating, and would not hasten her death. When my dad started hospice, he was given morphine and another drug which I can't remember. He died within a day of being on it so I did wonder if it had hastened his death. However, I have also thought that he just fought as hard to die as he did to live. He had late term COPD but also a stroke and faced being put into a care home. He had lived independently into his 90th year and didn't want to live unable to care for himself.
One day in the next ten years or so I will likely have to care for one or both of my parents during their end of life. I am going to work very closely with medical practitioners to keep them as comfortable and content as possible. I hope they sleep and rest lots and aren't in pain or anxious. I very much want the same for myself when the time comes.
Thank you for this thorough and clear description of “the box“. It really does help clarify both the misperceptions as well as the utilization of these medications to support the dying patient These drugs are given to ‘comfort the patient, not to comfort the family’ (I.e.: allow the dying process happen in each person’s own time with the least suffering for them. This isn’t always easy for the family to watch and may wish to hasten it.)
Just hearing this and reading some of the comments have been somewhat helpful to me. My mom passed Jan 6th in hospice. They had to give her some of these meds. The last few days were so hard to watch. As she didn’t recognize me or so it seemed. And she became combative, her arms moving around. And so forth. Broke my heart so bad. I often ask myself did I do something wrong, was there more I could have done to help her . I’ve lost my dad, husband ,grandson and sister. But to loose my mom has been a challenge.
Good Lord! I can see why some run to work in the pediatric ward dealing with babies as opposed to old folks. This lady is as noble as one can be and her calling unique ... may God always keep you energetic, extremely healthy and full of enthusiasm in Jesus Name!!!
I kinda get where you’re coming from, but I have a niece that is a pediatric emergency nurse. She would probably disagree. FYI, she worked in a nursing facility for years before her current position. She will tell you that both really suck!! She is a blessing to all that needs her. ❤️
my daughter is a delivery nurse,THAT is what she wanted to do and she's damn good at it,she's delivered one on her own so far, but you know, sometimes those little ones don't make it, that would only happen ONCE for me...
I so wish I had had all your wonderful information and my husband was dying of cancer back in 2010. When he was sent home from the hospital two days before he died, I knew nothing about active dying and really found have a lot right quick. Thank you so much for what you are doing to help other people, both those who are dying and their caretakers. May GOD bless you, in JESUS' name
Great info Julie!! My husband is on hospice now having been release home after a week in hospital. He has advanced Alzheimer's and metastatic prostate cancer. Because we did not opt for all of the testing to determine the whereabouts of the cancer because poor man could not handle all the tests, we don't know the extent of the cancer. He has always had back pain due to an arthritic spine. When he came home and I saw the morphine in the pack I was surprised. The hospice nurse explain when to use it and that it was not for one-shot pain. My husband was having consistent pain noticed by all the grimacing and squirming. Though he could not accurately describe his pain, I could see it. I started to use the morphine and he is so much better in that area. It really works. I am happy that at least he doesn't have to deal with pain on top of the confusion and so much more.
Thank you for this. My sister recently passed away on hospice and refused the comfort kit. It was very hard on us all as she was afraid to pass away and would rather be in excruciating pain. She did eventually when the pain was so bad, and agreed to allow the use of the comfort kit. We were so thankful to have a wonderful hospice team who took the time to explain what each medication was for. It gave us peace to know that my sister wasn’t in any pain and at peace when she passed. I found your channel a few weeks before she passed and it gave our whole family so much knowledge and comfort knowing we were supporting my sister the right way.❤
Julie: you explained them very well. And that's coming from a pharmacist for 40 years. By the way, Morphine could also cause constipation, hence, Bisacodyl would be good, usually works in 1 hour or less. Appreciate you. Blessings from LA
My dad developed an issue with his heart that multiple doctors said there was no coming back from. He was very agitated and was struggling with breathing. He was given morphine to ease the distress. One of his doctors even came to the hospital in the middle of the night to be with us as he passed. Fast forward 9 hours and dad opened his eyes and asked for biscuits and gravy. Morphine did not end his life in fact he lived for 7 more years. The doctors called him Lazarus.
Two years ago, husband near the end, liver disease, never on hospice because his decline came very rapidly. In hospital, was on dilaudid the last week, then upon his last evening (which of course was unbeknownst to us at the time) the palliative care doc added ativan to the list of options. I was aware that shallow breathing was a side effect, but said yes, anything to ease his suffering. He was probably around only eight more hours or so after starting on it. I know he was near the end anyway, but I feel that the ativan helped him out the door. So... sometimes, yes, mercifully, I think these compounds can hasten the process. It's not a bad thing, when someone is in great pain.
My Mother died in hospice within days of her arrival. With morphine she became much more agreeable and talkative having been in pain. It was great! I was urged to add ativan injection. I wish I hadn't. She immediately stopped talking and slept. That "golden time" instantly left and we didn't get it back...
My loved one had BPD and major depression all of her life. She finally, on hospice, had Lorazepam, and Halodol 3x day to control major agitation. She, for the first time in her adult life she was calm and accepting of psych care that she’d always refused when healthy. She died knowing her family really did care and she was not paranoid .I believe it was from proper medication.
In the UK, we call it a “Just Incase Box”, which I think is very sensitive to both those who want to know that these things are in the home for if and when, and also is sensitive to those who manage their dying by not wanting to acknowledge or talk about it so much. The term “Comfort Pack” is also a sensitive and kind way of putting it too.
Thank you for explaining this to everyone. I was the family member who was chosen to give my Mom the morphine around the clock. It was the hardest thing I have ever done. Love your lipstick color too.
Great video. My Mom just told me last night that she doesn't know what's all in the box and what it's for.... even though the hospice nurse just went all through this the day before. It is a lot, and overwhelming. Thanks for answers, as I was not there for that nurse visit. My Dad is in hospice. 😢
I have schizophrenia and yes you are right. Haldol is used to treat Schizophrenia. I'm always amazed when a med I know as one thing is also used to treat something else. I used to be on haldol in my wild twenties. I've calmed down a lot. I trust you. This video is very calming and informative. Thank you hospice nurse Julie! You're amazing and smart!! You should win woman of the year! I've also taken adivan as a PRN. I don't love adivan. I've switched to taking CBDs myself but some feel adivan really helps them. Whatever. Haha! Cheers! ❤🎉
Thank you, Nurse Julie, your videos helped prepare me for both of my parents demise. My mom and dad were a year apart in age, I am the eldest adult child & eldest daughter, I’m also their honeymoon baby. My mom and I made plans last October or November for me to go down and we would spend our birthdays together in May. It’s almost May and I’m getting ready to go back down with my husband the third time since February 2nd, 2024. My parents were moved to a 24 hour Hospice Home January 25th, because my mom fell hard, while my 5 siblings were visiting from out of state, that’s why my parents had to go to a 24 hour care home. My mom begged me to stay with her to the end & I promised I would be with her. My husband got Covid, my parents live in S. California & we live far away near the border with Canada. We had to rush home, get well & race back, because I knew my mom was dying, she has been since 2013, but she was extremely strong and didn’t want to leave my dad, but she fell in mid January and cracked her femur, her pai levels were soooo high. The week we returned at beginning of March, I knew mom was going downhill fast, and it was just me and my husband. My dad is deaf with dementia, he’s had dementia for 13 years or more, he kept trying to climb out of bed, but he lost the ability to stand & walk, he also lost the ability to read and he has aphasia now. My mom started transitioning on March 16th, I knew as soon as I saw her. Fortunately she had been able to tell me over and over how beautiful I am and how much she loves me, I was put in charge of mom’s comfort kit meds, she had stopped eating and drinking days before, I called my brother the night she started transitioning & the head of hospice told my brother to forget flying there, leave and drive fast, I texted my sister and she drove with my brother and they arrived the night of March 17th. My mom passed away at 7:03pm, March 19th, it’s April 17th, so less then a month ago. My dad isn’t doing well, he knows my mom is gone and he’s lost without her, this year would have been their 70th anniversary. Tears are streaming down my cheeks again. We leave in a few weeks to visit my dad, but also so I can take flowers to my moms grave on my birthday, hers is the week before mine, but we have a new granddaughter arriving soon & I have to stay and go to the baby shower…the circle of life, my mom was so happy I was going to be a grandmother again, I had an extremely difficult time getting pregnant, almost all my younger siblings had babies but not me, and when I finally got pregnant l I had very complicated pregnancies and hard births, I was beginning to think I would never be a mom or grandmother and I am super into children and babies, teenagers, I love being a mom, but I amiss my mom so much and my dad is not doing well.
After watching and listening to you Julie I lost my mom this month and knows what I did by following your channel made it easier for me to forgive what she said during death
The information given in these videos has been a godsend for me. It has really helped relieve my anxiety about end of life. I love nurseJulie. She brings normalcy to the process of death.
All this info is exactly what happened with my father's passing this past May. The meds I gave him was under the tongue. Because of these meds, Dad had a peaceful passing. Could you talk about the patient seeing things that were not there. About a month before his passing, my father (who was a rational man) would talk to people that were not there. One morning I heard him talking to himself about finding his shoes so he could fix his truck. He told me we were robbed during the night, and he got up looking for his gun and fell. Of course I found the gun and hid it. That could have been a disaster for me. He SD boy scouts came to his hospital room and gave him an enema. We laughed at some of the things he SD, but this was a big surprise to me. His hospice team told me this was normal. All this happened about a month before he died. Is this normal for the death process? Thank you for the wonderful work you do.
Nurse Julie has a number of videos on this topic. The medical term is visioning. It happens to many many hospice patients. It is normal and often brings comfort to the patient.
Great information. I am a Concierge at a Senior Living Community in the Atlanta area. Thanks for the information regarding what drugs are used for each issue a Resident needs
Thank you Nurse Julie my mom’s hospice company called it The End of Life Kit or e-kit. They started mom on morphine on Thursday, hyosyamine for secretions and procholperazine for nausea on Friday . Thankfully, we never had to do the Tynenol suppositories and she passed comfortably today on Sunday. Thank you for educating us about hospice care and end of life 🙏🏽
Youre such a special caring lady. Ive learned so much from yr videos. You are the best nurse ever & you know so much. Id love someone like you on my team when my time comes. You care so much & yr so in tune with every possible scenario of the dying process.
Why didn't you mention Oxycodone for pain Julie? I can't go a day without it because of the GBS I unfortunately acquired. I wish I didn't have to take any meds but I love all the good things life has to offer. Thanks again Julie
My grandma was force fed morphine by my uncle. She was saying “I don’t want it! I don’t want it!” I’ll never forget it. And hospice came in saying great job guys. I love these videos and learning more valuable info and I support nurse Julie. Just wanted to share my personal story.
I had never heard of a Macy catheter until my mom was on hospice. It was very helpful the last 2 days. She also developed a compulsive scratching. The ativan and haloperidol were helpful for that.
I agree with good old Morphine! I was a nurse fro 40 years and did a lot of palliative care at clients homes! A small dose of morphine would settle them down, help their pain and was great for shortness of breath! That was the question I got asked the most was aren’t you killing them quicker with Morphine and I would explain that it was for symptom relief and dying can be painful when your body is shutting down and they seemed to relax after education. I felt that education for the families and clients was the best first to end of life care! Love hearing your stories and information that you are giving to the public! Forever a nurse in NB Canada!
I'm very interested in morphine vs. benzodiazepines in COPD. My relative is having a lot of nighttime agitation and figeting, with significant sleep deprivation. I actually don't know if she is experiencing air hunger. Her voice is so weak and she is so tired. How do you assess it in such a situation?
Thanks for sharing this information. My Mom is in hospice in a skilled nursing facility, and she is on morphine and Ativan. A few days ago I had a meeting with her hospice team (or something like that). I told them that she seems to be anxious and in pain most of the time. She is unable to speak now and I asked if they could switch her meds from 'as needed' to a regular schedule. They agreed and my Mom seems more comfortable.
So glad hospice is all about the patients comfort. My neighbour was dying from a autoimmune condition & in a lot of pain. She was scolded by a nurse for going thru meds too quick bcos they're very addictive. She passed away about 3 mnths later. I've never heard anything so ridiculous. If I was suffering like that I'm sure I'd put a pillow over my own face.
I was offered the Ativan/morphine pack for my mother, who was "failing to thrive" at 92. Her time was limited, her agitation combined with slight dementia was sad to watch. Maybe not in all cases, but we all did this with the purpose of hastening her death, because of her weakened system. I respect what this video states, but we did this with purpose. My mother passed peacefully in her sleep just four days later, which was the goal. I wish this had been offered to my dad.
Careful admitting to that. Depending on where you live, it can be a crime to purposely hasten someones life even if they are old and in pain, without a doctor ok'ing it.
You once asked for ideas on future videos. How about last requests ? Someone I was once close to was dying in the hospital from liver disease. Family was all around her. She had been sober for awhile. I asked her if there was anything I could do for her. She said she wanted a drink of alcohol or bottle of alcohol. An elder present and I told her we couldn't do that. I often wonder if that was the right decision as she died shortly after.
My 88 year old mother, with insipient dementia, wound up in the hospital--not hospice--for some reason. Her boarding home sent her there and I got on a plane and set out to manage her care. Her doctor had put her on friggin' Haldol. She got the dreaded tardive as a consequence. I was livid. My mother wasn't crazy, just old! It broke my heart to see her scratching at her lips and looking zonked. I don't care for that drug. At any rate, she moved to a nursing home and lived for another year-and-a-half, without Haldol, but with some sedation.
Morphine Was a blessing while my mom was on hospice. With Alzheimer's she couldn't swallow in the end. But the morphine kept her comfortable as soon as administered under her tongue even though she couldn't swallow. She would relax and seemed happy. The last 48 hours her need increased a lot. Before that she only took a small amount at bedtime, as she didn't sleep much. It did so much to ease her suffering.
The lack of sleep is debilitating. I think it is a major negative quality of life impact on my relative. She is constantly figeting and playing with the oxygen tube.
The hospice agency we selected for my mom *used* to be allowed to place a Comfort Kit in the home at the beginning of care for every patient. The opioid crisis led to new restrictions, however, and in 2019, when my mom was dying, Michigan nurses could not even carry them in their cars. I don't know if the situation has changed since then, but at the time a doctor's order was required and the Comfort Kit had to be *mailed* from the pharmacy to the home. We didn't yet have a Comfort Kit in the home when the on-duty nurse realized we needed one. It was Sunday, and there was no way to get help from a pharmacy until Monday. So, tip #1 is: ask about the Comfort Kit first thing.
My mom died on hospice six months to the day. Morphine used day before actual death. Ativan etc before that. She went fast and comfortable My Dad was in comfort care for six days before he passed in his sleep. The day before he spent entire day with me and my daughters and grandchild. It was lovely. Passed when we left him. My sister passed used MAID in Colorado two years ago. Entire family gone in three years. So sad 🙏🏻
My husband died in August 2023. He never wanted to go on hospice but the Dr said that was the only option. He was on hospice less than a week before he passed. I still haven’t gotten over the guilt of him being on hospice. I feel like it did make him die faster. I just hope he wasn’t in any pain. The night before he passed he was constantly taking his oxygen off and we had to put it back on. While he was on hospice he was always checking his O2 saturation. Nine months later I still can’t get over everything. Thanks for your video❤️
@@hospicenursejulie yes I take it every day , once in the morning and once at night.. I've been taking this medication along with other pain meds for about 25 years now..
@carolemantha8958 I take methadone too and im terrified of someone yanking it because they.believe im "comfortable" and dont need it because im out of it. I dont want to be thrown into withdrawal and not be able to tell anyone so am forced to suffer.
My late father had a feeding tube.. 19 months. On Oxygen A trek .. his last 19 months .. was horrible A Self Made Man with an infectious laugh Couldn’t Laugh Couldn’t speak Couldn’t Eat My mother would crush.. whatever & put in his tube .. Cleaned out his trek.. in the throat This was his 2nd bout w/esophageal cancer IT SUCKED SO BADD WATCHING HIM DETERIORATE @78 yrs old.!!! 🙏🏼🩵🙏🏼🩵🙏🏼 Then 2- months later .. my one & only brother Passed .. both gone My 2- main Go Too Men Gone in a NY MINIT🙏🏼🙏🏼
Have you done an episode on what happens to a person who has the "drink". Not just to their body but the difference between natural and what the person would feel.
I only hope that when my time comes that there are people who will make me as comfortable as I can possibly be, and if it hastens my end, so be it so long as I’m not scared and comfortable❤
My 85 yo MIL is on hospice in our home being cared for by my wife. MIL just fights and rebels against anything being done for her. She's all there in her mind, but it's her body giving out on her. She kept insisting there's something they can do to fix her inability to consistently keep food down. So hospice nurse lowered the boom and told her she's dying but her mind refuses to accept it. Assured her she will be kept pain free and comfortable. This has been a 7 month ordeal so far and it seems as though the end may be not far off. She's gotten very thin from weight loss due to nausea and vomiting. She's got cancer somewhere probably stomach related. Starrted 2 years ago ovarian cancer.
Morphine can Stop Your Breath if You Take or Give Too Much..A Mother Begged me to Give her the Full Bottle of Roxinol to Give to Her son, to End His Suffering from a Comatic State he was in From Mad Cow Disease. I felt so sorry for Her Having to Watch her 35 year old Son Lay there and Suffer, but He was only Ordered so much, Sublingually every hr to control Pain. Your Video's are Great, Thanks!
I wish hospice had told ne about Tylenol suppository cause that was mums choice for pain throughout her life. She hated anything that could make her drowsy and would refuse strong pain meds. I used Ativan for the longest recommended by Hospice to use it. When i asked for additional medicine just in case she could feel pain they prescribed oxycodone along with the Ativan.
I recently went through 3 months of hospice with my mom. Not sure how we would have gotten through the process without the comfort meds. I am concerned about this same journey with my dad who has Parkinson’s and is also allergic to morphine! How are the comfort meds adjusted for those with allergies and those who cannot take anti-psychotic drugs?
@@sillylilysallykaye4917. I am on hospice and nobody offered me the comfort kit and I have no pain medicine and I have stage four non-small cell lung cancer metastasize to the other side of my lung. How come I didn’t get any pain medicine
My husband has multiple system atrophy and has been on in-home hospice since May 2023. We were given a comfort pack the day we were put on hospice and have had to use many of the items. Hospice has been so good for both of us. The hospice nurse, social worker, and other team members have been fantastic. A big shout out to all hospice workers. You help make the end of life better for our loved ones❤❤❤❤!
My prayers are with you. My husband also has MSA and is currently edging towards his final days. Hospice nurses are awesome. These meds are helping him so much but also helps me to see him in less pain and agitation. These videos have answered so many questions.
Thank you for your reply. Sending comforting and peaceful thoughts to you and your husband.
Thank you so much for this informative video. I am 85 & of course death looms nearer, I have CLL & hope to benefit with hospice care when my time comes, thanks to the fantastic carers and nurses who have such compassion for their patients❤
My mother passed at 94 y.o. on 8/29/23. Yes, my mother was on a few meds stated in the video. Truly is a misconception that morphone delays or quickens death. Lorazepam was used for the last 4 weeks and morphine 5 days prior to her passing. She died peacefully, and as they say, you die as you live. My mother was at peace in life and had a deep faith all her days so she was fairly easy (my mother wasn't very verbal). She was on hospice 6 weeks at home. Rest in peace mom, you are missed and loved by many! She was from a generation of 'tough' lineage. You think you're prepared but losing your mother is a void! I am a part of her! *tears 🥲
I’m sorry about your mom . I lost my mom almost 2 years ti the day. It’s a pain like no other
I’m so sorry your mother has passed, the void in our lives without our mother is a pain that doesn’t really go away. My mom was from that “ tough generation” they lived through some very hard times, yet they gave us the example of how to carry on with our life. My mom has been gone for 20 years but I think of her every day. She was a small lady but had the fortitude of a giant.
Alzheimer’s took her from us. It was hard to watch her decline.
{{Hugs}}🥺
I’m so sorry for your loss. My dad died 8/28/23 of cancer. I’m heartbroken 💔
@@conniescher3359I'm so sorry for the loss of your dad. My father also just passed 10/24/23 from pancreatic cancer & I miss him like no other 😢😢
My thoughts, having gone thru this twice with my parents, & currents with my brother: Morphine- keep giving it right to the very end because you don't know if they are in pain or not. Also, air hunger brings with it a great deal of anxiety. 2. Lorazepam- Dying can be scary stuff. Anything to help lower that anxiety is a blessing. 3. Haldol- Also helps with agitation & anxiety. Atripine is more for the people caring for someone at the end of life. You don't get that sound out if your head, & it can get VERY loud. It's also the sound that sticks with you. Those drops under the tongue are a blessing.
Are you saying that the caregivers should/ could/ would take the attripine?
@sharonparker5277 NO! Caregivers should administer the Atripine to the patient, because listening to the often very loud noise is heart-rending & traumatic. By the time tge death rattle comes, the patient is no longer aware.
Thanks for this information. I am sorry you have had to go through this several times but it is very useful information and I appreciate you posting. As someone with a terminal illness I find this sort of information very comforting. Just a comment with the death rattle, my understanding is that this does not affect the dying person themself, but it sounds like this is a difficult thing for loved ones to witness.
Morphine speeds up the death process. They will give it to everyone, it's for pain so everyone doesn't need it.
I’m not ready to think about how my mama passed
My grandma had that misconception when my dad passed on hospice, even after my grandpa had been on hospice 20 yrs ago. Her husband was bedbound for weeks, then had pill morphine before getting it delivered by nebulizer. My dad, who had gone on hospice a week before, was ready. He had made peace with everyone, had talks, etc. He just needed that ativan for nerves, because he was afraid he remembered watching his dad die from the same thing. And he was on just enough morphine to relieve his pain, so he could be comfortable eat. And this helped him BE AT PEACE. And it helped him to do what he wad ready to do, let go.
Thank you for explaining end of life medication uses for the patient AND caregiver. I remember my parent's last air breath and it's been 7 & 8 years ago.
I've been cleaning house for my 88 year old neighbor and she was just fine until 4 or 5 weeks ago she started having a bloated stomach and having an even harder time breathing due to emphysema or what they now call COPD. I'm just in shock still of how fast this came on. She is now home in hospice care. Her husband I'm the most worried about. They have been together for 48 years. I'm not sure what to say or do to help this wonderful man and his beautiful wife but i know i will be there till the end....no matter how hard it gets for me it is 100 × harder for him. God bless all of you care givers.
Hope you'll be able to stay on with him after her passing. Just having you present will likely be a big help to him. Bless you for caring.
With my mom, Lorazepam/Ativan triggered an increase of hallucinations. We had to talk with the nurse and doctor to adjust her medications to settle her down. Don't be afraid to talk with the hospice nurse and the doctor should anything change. Thank you for your excellent videos.
Same with my grandma that I’m going through right now with her, we got them to switch to Xanax, and she’s a LOT more peaceful. The hospice nurse tried arguing with me saying they are the same thing and I had to explain to her they are indeed not the same thing. Were hit and miss with hospice nurses
What ended up working for you? We're dealing with a lot of nighttime agitation/figeting leading to severe sleep deprivation.
@@gregorymalchuk272 Xanax, my grandma passed while on hospice on 7/9 unfortunately. Raised me by herself since birth. At the end she was on 1mg Xanax every 3 hours, along with Haldol every 3, Dilaudid every 4, two fentanyl patches 50mics each, so be careful and only reserve for extreme sundowners. She was an EXTREME sundowner. Put that was easily enough meds to kill her so I held some of her last nights dose and she slept through the night, I knew if I gave it to her, that would be it. I could just see it in her breathing. So we dealt with it at around 4 am, but she slept most of the night which was unheard of until the Xanax. Ativan is not a good drug for this (I’ve been on benzos my entire life just about, trust me on this), you need Xanax for the sundowners if Ativan is not having a good enough effect. I have her the last 1mg of Xanax and 3mg Haldol, and a few hours later me and my aunt were talking with my aunt with her back to my grandma, and I noticed she went from breathing super shallow and frequently the night before to BIG DEEP breaths very spaced out and I said “this is it” and we went over and each held one of her hands, there was like 4 of us, and it wasn’t probably 2 more breaths if that and that was it. I miss her every day. But MAKE those fucking hospice doctors do what is NEEDED. Not what the “book says” or what they want. I wish you the best in these terrible circumstances. Just call hospice and tell them, not ask, tell them that SOMETHING STRONGER IS NEEDE if they are still suffering. Pulling at their clothes and bedding is common, yelling is common. My grandma was constantly yelling “oh god, please help me” all night. It was absolutely brutal. The Xanax was the only drug that helped. You need a strong benzo and haldol, and make sure they aren’t feeling a thing. That’s it. If a hospice nurse tries to argue and say “well Xanax is more potent than Ativan and blah blah”. Remind them, SO FUCKING WHAT? They’re dying. I had to get loud with the hospice doctor, but sure enough the Xanax and Dilaudid were called in that morning. So do what you have to do, and fight them on it if you have to. That “emergency care kit” is mostly garbage that won’t help a large percentage of people. Particularly the Ativan. Again, we have Xanax for a reason, so do what you need to do. Good luck, you’re not alone.
@@gregorymalchuk272 see my above reply
I have been watching your posts for months preparing for the passing of my 103 year old father. You really helped me prepare and help some other family members as the end of life secretions started 8 days ago. Dad passed away quietly on Wednesday evening. We had to not use the word hospice around him as he believed that was a process to end your life rather than ease your life end.
Thanks so much for helping me to prepare (you never really can).
Thank you Nurse Julie. I'm trying to understand these medications for use for myself when I need to go into hospice care. (Hopefully a long while from now) I'm most concerned with shortness of breath, pain, and panic attacks. I've heard horror stories about people at the end of life with lung diseases and how some were "gasping for breath". I have stage 3 COPD and want to have my family ready for any medication I may need. Ty again for an informative video. Love ❤ from Ohio
Greetings from South Africa ... similar with me except I dont have any family
I’m not a doctor, but I do know about hospice and a hell of a lot about meds. My whole family is either doctors or RN’s. They will start you on morphine and Ativan at first most likely. My grandma has COPD, cancer, lungs working at 20%, cellulitis, diabetes, CHF, you name a thing, she has it, and she’s in hospice right now. If the Ativan doesn’t work and your caretakers see you’re still agitated, tell them in advanced to push for Xanax, this did WONDERS for my grandma. People think all benzos are the same when they are no where close. She has the worst anxiety naturally before all this of anyone I know besides myself (I’m on Xanax 3x daily). The morphine wasn’t enough for the pain so we upped to Hydromorphone (Dilaudid…about 10 times stronger than morphine). Then when that didn’t cut it we upped her to fentanyl patch (about 100 times stronger than morphine). Then when that wasn’t enough we upped her to two fentanyl patches. So she doesn’t feel a thing, she’s getting Xanax and Haldol at the same time, so she is as calm as you can possibly be. We all talked with her one by one before we have her the heavy stuff. But she’s still powering through all of that, which would be enough to knock out a lumberjack for 3 days. My grandma is a strong ass woman, she raised me (grandson) and many many other kids that weren’t her own. And she taught us well and brought us up well. I lived with her from birth until I moved out with my wife and still saw her at minimum once a week. I’d stay at her house before she had to be hospitalized for days on end and talk with her. But long story short, you’ll be comfortable. Just have that conversation early with your family and make damn sure they stay on the hospice nurses ass. Some are amazing and caring, some it’s just a paycheck to them. So sometimes you do have to fight them to get the meds you need. You know your family way better than some nurse that just met her 5 mins ago. But don’t worry about panic attacks, that will be completely controlled. You’ll be completely out of pain and dreaming about whatever your favorite things are.
@@all4paws508well you have me my friend, I’ll be your family. Greetings from Daytona Beach, Florida.
@@justinfarris5584 Bless u! I feel quite emotional now
Hi Joy don't u think that the nurses will determine what medications you might need at that stage...depending on your specific situation? Your family won't be able to order any medication either. The aim of hospice is to make patients comfortable. They'll take good care of you ❤
My dad died on hospice this year and I was the one to give him the final dose(s) of morphine. While rationally I know it only helped ease his suffering, and did not 'kill' him, sometimes bad thoughts creep in. It is so comforting to hear your words and explanations. Thank you, Nurse Julie.
I have stuggled with this myself
I can’t tell you how helpful having that comfort pack was in my sister’s refrigerator. We never needed to use it, but I loved knowing it was there.
💖💖💖💖💖💖
I’m very grateful for this relevant info-where else would I learn this so graciously and conversationally?
My mother in law was in hospice care before she passed. She was diagnosed with stage 4 lung cancer less than 6 weeks prior to her death. She was very frightened of pain and asked us to make sure she didn’t die in pain. Our wonderful hospice nurse made sure she was given sufficient morphine to diminish her pain. My mother passed in a hospice care center and I can’t say enough good things about her care there before she passed.
My Dad died last year. He had his first visit on a Friday and the following Monday night, things went terribly downhill. The only call hospice nurse was called two times. Each time she came to see him, writhing in horrific pain, she said she she could not give him anything for pain because the nurse who had been assigned to his case had forgotten to submit the order to the physician for approval. The sweetest man on earth, suffered horribly and needlessly until his death the next morning. Losing my Dad in this way, knowing how he suffered, has destroyed me.
I'm so sorry for your loss.
You should complain to whoever because this should not happen This is pure neglect we all want to leave this world without pain and now there’s no need to how disgraceful Sorry you had to witness this poor professional behaviour.
They are dying…. they should be given whatever they ask for. Who cares at that point? It’s totally ridiculous if that man had to suffer that way. I’m asking for the Morphine the first day of Hospice care 😑
@@ITSMEBETTY50the worse part is that in the hospital if there is no family, they will give them Haldol and fentanyl and knock them out, it’s called a “sleep till the next shift dose”. Or they will give a “nurses dose” which is a real thing, where if they are truly suffering in agony and nothing else will work, they will hit them with just a smidge too much morphine
I recently learned that you can call 911 to administer pain meds.
My mother was on a morphine drip. She had a tube implanted into her chest that then connected to a black bag that had a pump inside of it. It measured out a certain amount 24/7 then there was a little handheld thing where she could push a button and it would give a boost. That boost could only be given every 10 minutes (or 15, I can't remember as this was back in 1999) otherwise she wasn't given anything. She had pancreatic cancer, cancer in the lower lobe of her right lung and cancer in her liver.
The hospice nurses were the ones that refilled the morphine pump.
I'm so sorry about your mother. I also had that same experience my mom also had pancreatic cancer and given morphine. I just hate that its so painful and nothing i could do for her but beg for more pain meds that would keep her out of pain 😢 I hate that for anyone that knows how painful it is to go through that kind of cancer. That was almost 20 years ago
@@lubans369 I am sorry you know what that's like, too. Big hugs from me to you. The worse part is when the tube that delivered the morphine somehow got a hole in it. It was leaking down her side under her shirt and she didn't notice until suddenly she was in such severe pain that she was begging me to kill her. Luckily there was still a bottle of Dilaudid leftover from before they put the tube in and I was able to give her a couple of those to hold her over as she was rushed to the hospital to get a new tube inserted. I still get nightmares from that night with her crying and begging me to kill her.😭
I'm so sorry
@@dora_the_explorer975 thank you. I am actually grateful that I stayed with her in her home until she died. It allowed her and I time to be together and to say goodbye. It was very hard but I would do it all over again if I could.❤️
@@Simsane I understand. Very precious memories but bittersweet.
Nice to hear how patients are cared for in a hospice setting. In the hospital we usually put patients on Morphine, Ativan and sometimes Dilaudid and Fentanyl drips , use Robinul IV to dry up secretions as well as Atropine drops. The Dulcolax suppository is the most underutilized drug in my opinion.
We were told in nursing school, and in clinical settings, that morphine can hasten death BUT as long as the intention was to relieve suffering, then it’s ok. Although it can appear as if death is being hastened, it’s actually the disease process taking over, in the absence of conflicting symptoms.🙏🏻
Morphine gives relief from several issues related to dying. The patients are in the process of dying
@@Moluccan56 I fixed it
@@arribaficationwineho32 Thank you…i can remove my remark. And then this one.
@@Moluccan56 it is infuriating that family blames nurses for “killing momma” with morphine in a hospice situation
@@arribaficationwineho32 I’m disappointed that this happens. The end of their life is inevitable, the patient is not going to get up and have a coffee and chat with them, they are headed toward permanent sleep. These people don’t seem to be coping with reality in the best way and I think nurses are familiar with it. Hospice staff are angels on earth.
My mother has been on hospice a few months now. She is not getting much relief from the Norco so they have put her on Morphine. My sister and I were so scared of this but my mom is so much more comfortable now with it. Thank you for this video. It was very reassuring.
Thankyou Nurse Julie. I admire you for getting g this stuff out there and educating people. Another thing is fluids. Many people think dying people must have fluids. As you know, the body is preparing to pass, giving fluids only puts pressure on the organs. Thankyou for all you do 🙏🙏🙏🙏
I am a pharmacist and see a lot of these packs , I often think about who it’s going to and send love.I often wonder about giving benzodiazepines but my friend had great fear of dentists and was given some midozalam , she felt as if she had no care about what happened,So I suppose it may be a great help.I often wonder about my end.I want to be conscious as I am a believer in continuation.
It’s a real dilemma because none of us knows how we will die.I have sat with dying who had no one but the one I am thinking of was already out of it and I left him in peace to go after giving him the Buddhist sutra reading he asked for before I got there
He died not long after I left and I swear he smiled while I was reading.
Great work you are doing.
Thank you for your comments about how morphine works to comfort in dying, not to hasten death. My mother died in a hospital, having been admitted for respiratory failure. She was given a liquid morphine under the tongue. A nurse friend called it Roxanol and explained to me how it kept my mother from feeling like she was suffocating, and would not hasten her death. When my dad started hospice, he was given morphine and another drug which I can't remember. He died within a day of being on it so I did wonder if it had hastened his death. However, I have also thought that he just fought as hard to die as he did to live. He had late term COPD but also a stroke and faced being put into a care home. He had lived independently into his 90th year and didn't want to live unable to care for himself.
Morphine was a blessing to my mom in her last days.
One day in the next ten years or so I will likely have to care for one or both of my parents during their end of life. I am going to work very closely with medical practitioners to keep them as comfortable and content as possible. I hope they sleep and rest lots and aren't in pain or anxious. I very much want the same for myself when the time comes.
Thank you for this thorough and clear description of “the box“. It really does help clarify both the misperceptions as well as the utilization of these medications to support the dying patient
These drugs are given to ‘comfort the patient, not to comfort the family’ (I.e.: allow the dying process happen in each person’s own time with the least suffering for them. This isn’t always easy for the family to watch and may wish to hasten it.)
Just hearing this and reading some of the comments have been somewhat helpful to me. My mom passed Jan 6th in hospice. They had to give her some of these meds. The last few days were so hard to watch. As she didn’t recognize me or so it seemed. And she became combative, her arms moving around. And so forth. Broke my heart so bad. I often ask myself did I do something wrong, was there more I could have done to help her . I’ve lost my dad, husband ,grandson and sister. But to loose my mom has been a challenge.
Good Lord! I can see why some run to work in the pediatric ward dealing with babies as opposed to old folks. This lady is as noble as one can be and her calling unique ... may God always keep you energetic, extremely healthy and full of enthusiasm in Jesus Name!!!
I kinda get where you’re coming from, but I have a niece that is a pediatric emergency nurse. She would probably disagree. FYI, she worked in a nursing facility for years before her current position. She will tell you that both really suck!! She is a blessing to all that needs her. ❤️
my daughter is a delivery nurse,THAT is what she wanted to do and she's damn good at it,she's delivered one on her own so far, but you know, sometimes those little ones don't make it, that would only happen ONCE for me...
Blessings always Thank you
I so wish I had had all your wonderful information and my husband was dying of cancer back in 2010. When he was sent home from the hospital two days before he died, I knew nothing about active dying and really found have a lot right quick. Thank you so much for what you are doing to help other people, both those who are dying and their caretakers. May GOD bless you, in JESUS' name
Great info Julie!! My husband is on hospice now having been release home after a week in hospital. He has advanced Alzheimer's and metastatic prostate cancer. Because we did not opt for all of the testing to determine the whereabouts of the cancer because poor man could not handle all the tests, we don't know the extent of the cancer. He has always had back pain due to an arthritic spine. When he came home and I saw the morphine in the pack I was surprised. The hospice nurse explain when to use it and that it was not for one-shot pain. My husband was having consistent pain noticed by all the grimacing and squirming. Though he could not accurately describe his pain, I could see it. I started to use the morphine and he is so much better in that area. It really works. I am happy that at least he doesn't have to deal with pain on top of the confusion and so much more.
This is great ! Watching your channel should be a requirement for Drs. And nurses!!!!
Thank you for this. My sister recently passed away on hospice and refused the comfort kit. It was very hard on us all as she was afraid to pass away and would rather be in excruciating pain. She did eventually when the pain was so bad, and agreed to allow the use of the comfort kit. We were so thankful to have a wonderful hospice team who took the time to explain what each medication was for. It gave us peace to know that my sister wasn’t in any pain and at peace when she passed. I found your channel a few weeks before she passed and it gave our whole family so much knowledge and comfort knowing we were supporting my sister the right way.❤
Julie: you explained them very well.
And that's coming from a pharmacist for 40 years.
By the way, Morphine could also cause constipation, hence, Bisacodyl would be good, usually works in 1 hour or less.
Appreciate you.
Blessings from LA
I say, might as well be as comfortable as possible in hospice so you can enjoy spending time with loved ones ❤😄 TY for these vids!
As usual, an excellent, informative video by somebody who is obviously very caring.
Thank God for hospice care.🙏🏻🙏🏻
My dad developed an issue with his heart that multiple doctors said there was no coming back from. He was very agitated and was struggling with breathing. He was given morphine to ease the distress. One of his doctors even came to the hospital in the middle of the night to be with us as he passed. Fast forward 9 hours and dad opened his eyes and asked for biscuits and gravy. Morphine did not end his life in fact he lived for 7 more years. The doctors called him Lazarus.
Two years ago, husband near the end, liver disease, never on hospice because his decline came very rapidly. In hospital, was on dilaudid the last week, then upon his last evening (which of course was unbeknownst to us at the time) the palliative care doc added ativan to the list of options. I was aware that shallow breathing was a side effect, but said yes, anything to ease his suffering. He was probably around only eight more hours or so after starting on it. I know he was near the end anyway, but I feel that the ativan helped him out the door. So... sometimes, yes, mercifully, I think these compounds can hasten the process. It's not a bad thing, when someone is in great pain.
My Mother died in hospice within days of her arrival. With morphine she became much more agreeable and talkative having been in pain. It was great!
I was urged to add ativan injection.
I wish I hadn't. She immediately stopped talking and slept. That "golden time" instantly left and we didn't get it back...
What was she ill with, and was there much pain with it? Or was the morphine given for air hunger in respiratory failure?
I definitely want to be on as much comfort medicine as possible when I go
My loved one had BPD and major depression all of her life. She finally, on hospice, had Lorazepam, and Halodol 3x day to control major agitation. She, for the first time in her adult life she was calm and accepting of psych care that she’d always refused when healthy. She died knowing her family really did care and she was not paranoid .I believe it was from proper medication.
Good information for those who have parents and loved ones in hospice. Thank you Julie.... Stay Gold!
In the UK, we call it a “Just Incase Box”, which I think is very sensitive to both those who want to know that these things are in the home for if and when, and also is sensitive to those who manage their dying by not wanting to acknowledge or talk about it so much. The term “Comfort Pack” is also a sensitive and kind way of putting it too.
You’re 🌟!! 🙏🙏 🙏 for all the info! So calming and interesting!! xx
Thank you for explaining this to everyone. I was the family member who was chosen to give my Mom the morphine around the clock. It was the hardest thing I have ever done. Love your lipstick color too.
Great video. My Mom just told me last night that she doesn't know what's all in the box and what it's for.... even though the hospice nurse just went all through this the day before. It is a lot, and overwhelming. Thanks for answers, as I was not there for that nurse visit. My Dad is in hospice. 😢
I have schizophrenia and yes you are right. Haldol is used to treat Schizophrenia. I'm always amazed when a med I know as one thing is also used to treat something else. I used to be on haldol in my wild twenties. I've calmed down a lot. I trust you. This video is very calming and informative. Thank you hospice nurse Julie! You're amazing and smart!! You should win woman of the year! I've also taken adivan as a PRN. I don't love adivan. I've switched to taking CBDs myself but some feel adivan really helps them. Whatever. Haha! Cheers! ❤🎉
Thank you, Nurse Julie, your videos helped prepare me for both of my parents demise. My mom and dad were a year apart in age, I am the eldest adult child & eldest daughter, I’m also their honeymoon baby. My mom and I made plans last October or November for me to go down and we would spend our birthdays together in May. It’s almost May and I’m getting ready to go back down with my husband the third time since February 2nd, 2024. My parents were moved to a 24 hour Hospice Home January 25th, because my mom fell hard, while my 5 siblings were visiting from out of state, that’s why my parents had to go to a 24 hour care home. My mom begged me to stay with her to the end & I promised I would be with her. My husband got Covid, my parents live in S. California & we live far away near the border with Canada. We had to rush home, get well & race back, because I knew my mom was dying, she has been since 2013, but she was extremely strong and didn’t want to leave my dad, but she fell in mid January and cracked her femur, her pai levels were soooo high. The week we returned at beginning of March, I knew mom was going downhill fast, and it was just me and my husband. My dad is deaf with dementia, he’s had dementia for 13 years or more, he kept trying to climb out of bed, but he lost the ability to stand & walk, he also lost the ability to read and he has aphasia now. My mom started transitioning on March 16th, I knew as soon as I saw her. Fortunately she had been able to tell me over and over how beautiful I am and how much she loves me, I was put in charge of mom’s comfort kit meds, she had stopped eating and drinking days before, I called my brother the night she started transitioning & the head of hospice told my brother to forget flying there, leave and drive fast, I texted my sister and she drove with my brother and they arrived the night of March 17th. My mom passed away at 7:03pm, March 19th, it’s April 17th, so less then a month ago. My dad isn’t doing well, he knows my mom is gone and he’s lost without her, this year would have been their 70th anniversary. Tears are streaming down my cheeks again. We leave in a few weeks to visit my dad, but also so I can take flowers to my moms grave on my birthday, hers is the week before mine, but we have a new granddaughter arriving soon & I have to stay and go to the baby shower…the circle of life, my mom was so happy I was going to be a grandmother again, I had an extremely difficult time getting pregnant, almost all my younger siblings had babies but not me, and when I finally got pregnant l I had very complicated pregnancies and hard births, I was beginning to think I would never be a mom or grandmother and I am super into children and babies, teenagers, I love being a mom, but I amiss my mom so much and my dad is not doing well.
After watching and listening to you Julie I lost my mom this month and knows what I did by following your channel made it easier for me to forgive what she said during death
The information given in these videos has been a godsend for me. It has really helped relieve my anxiety about end of life. I love nurseJulie. She brings normalcy to the process of death.
All this info is exactly what happened with my father's passing this past May. The meds I gave him was under the tongue. Because of these meds, Dad had a peaceful passing. Could you talk about the patient seeing things that were not there. About a month before his passing, my father (who was a rational man) would talk to people that were not there. One morning I heard him talking to himself about finding his shoes so he could fix his truck. He told me we were robbed during the night, and he got up looking for his gun and fell. Of course I found the gun and hid it. That could have been a disaster for me. He SD boy scouts came to his hospital room and gave him an enema. We laughed at some of the things he SD, but this was a big surprise to me. His hospice team told me this was normal. All this happened about a month before he died. Is this normal for the death process? Thank you for the wonderful work you do.
Nurse Julie has a number of videos on this topic. The medical term is visioning. It happens to many many hospice patients. It is normal and often brings comfort to the patient.
Great information. I am a Concierge at a Senior Living Community in the Atlanta area. Thanks for the information regarding what drugs are used for each issue a Resident needs
Thank you Nurse Julie my mom’s hospice company called it The End of Life Kit or e-kit. They started mom on morphine on Thursday, hyosyamine for secretions and procholperazine for nausea on Friday . Thankfully, we never had to do the Tynenol suppositories and she passed comfortably today on Sunday. Thank you for educating us about hospice care and end of life 🙏🏽
Youre such a special caring lady. Ive learned so much from yr videos. You are the best nurse ever & you know so much. Id love someone like you on my team when my time comes. You care so much & yr so in tune with every possible scenario of the dying process.
Bless you for all your posts.
Why didn't you mention Oxycodone for pain Julie? I can't go a day without it because of the GBS I unfortunately acquired. I wish I didn't have to take any meds but I love all the good things life has to offer. Thanks again Julie
Thank you so much for this informative video! I love your videos ❤❤
My grandma was force fed morphine by my uncle. She was saying “I don’t want it! I don’t want it!” I’ll never forget it. And hospice came in saying great job guys.
I love these videos and learning more valuable info and I support nurse Julie. Just wanted to share my personal story.
That's awful that her will was not respected. She said no, that should have been respected.
Julie, you're an amazing RN!
Very helpful, thank you!
I had never heard of a Macy catheter until my mom was on hospice. It was very helpful the last 2 days. She also developed a compulsive scratching. The ativan and haloperidol were helpful for that.
Very helpful info Julie....Thank you & God bless........
YOUR VIDEOS ARE SO HELPFUL AND EDUCATIONAL!!!
Thank you for this most important detailed information. It is more helpful than you know.
Great info, I specialise in end of life care and enable my clients to die at home in the UK. We call these JIC meds.. just in case 😊
Thank you again for all you do❤❤❤❤❤❤❤❤❤❤
I agree with good old Morphine! I was a nurse fro 40 years and did a lot of palliative care at clients homes! A small dose of morphine would settle them down, help their pain and was great for shortness of breath! That was the question I got asked the most was aren’t you killing them quicker with Morphine and I would explain that it was for symptom relief and dying can be painful when your body is shutting down and they seemed to relax after education. I felt that education for the families and clients was the best first to end of life care! Love hearing your stories and information that you are giving to the public! Forever a nurse in NB Canada!
I'm very interested in morphine vs. benzodiazepines in COPD. My relative is having a lot of nighttime agitation and figeting, with significant sleep deprivation. I actually don't know if she is experiencing air hunger. Her voice is so weak and she is so tired. How do you assess it in such a situation?
Thanks for sharing this information. My Mom is in hospice in a skilled nursing facility, and she is on morphine and Ativan. A few days ago I had a meeting with her hospice team (or something like that). I told them that she seems to be anxious and in pain most of the time. She is unable to speak now and I asked if they could switch her meds from 'as needed' to a regular schedule. They agreed and my Mom seems more comfortable.
I just recently learned about the 'Macy Catheter', BRILLIANT!
Hospice is wonderful!! Thank you for this information, I think you really ease people's minds❤
So glad hospice is all about the patients comfort. My neighbour was dying from a autoimmune condition & in a lot of pain. She was scolded by a nurse for going thru meds too quick bcos they're very addictive. She passed away about 3 mnths later. I've never heard anything so ridiculous.
If I was suffering like that I'm sure I'd put a pillow over my own face.
I was offered the Ativan/morphine pack for my mother, who was "failing to thrive" at 92. Her time was limited, her agitation combined with slight dementia was sad to watch. Maybe not in all cases, but we all did this with the purpose of hastening her death, because of her weakened system. I respect what this video states, but we did this with purpose. My mother passed peacefully in her sleep just four days later, which was the goal. I wish this had been offered to my dad.
Careful admitting to that. Depending on where you live, it can be a crime to purposely hasten someones life even if they are old and in pain, without a doctor ok'ing it.
Great video
You once asked for ideas on future videos. How about last requests ? Someone I was once close to was dying in the hospital from liver disease. Family was all around her. She had been sober for awhile. I asked her if there was anything I could do for her. She said she wanted a drink of alcohol or bottle of alcohol. An elder present and I told her we couldn't do that. I often wonder if that was the right decision as she died shortly after.
My 88 year old mother, with insipient dementia, wound up in the hospital--not hospice--for some reason. Her boarding home sent her there and I got on a plane and set out to manage her care. Her doctor had put her on friggin' Haldol. She got the dreaded tardive as a consequence. I was livid. My mother wasn't crazy, just old! It broke my heart to see her scratching at her lips and looking zonked. I don't care for that drug. At any rate, she moved to a nursing home and lived for another year-and-a-half, without Haldol, but with some sedation.
Morphine Was a blessing while my mom was on hospice. With Alzheimer's she couldn't swallow in the end. But the morphine kept her comfortable as soon as administered under her tongue even though she couldn't swallow. She would relax and seemed happy. The last 48 hours her need increased a lot. Before that she only took a small amount at bedtime, as she didn't sleep much. It did so much to ease her suffering.
The lack of sleep is debilitating. I think it is a major negative quality of life impact on my relative. She is constantly figeting and playing with the oxygen tube.
The hospice agency we selected for my mom *used* to be allowed to place a Comfort Kit in the home at the beginning of care for every patient. The opioid crisis led to new restrictions, however, and in 2019, when my mom was dying, Michigan nurses could not even carry them in their cars. I don't know if the situation has changed since then, but at the time a doctor's order was required and the Comfort Kit had to be *mailed* from the pharmacy to the home. We didn't yet have a Comfort Kit in the home when the on-duty nurse realized we needed one. It was Sunday, and there was no way to get help from a pharmacy until Monday. So, tip #1 is: ask about the Comfort Kit first thing.
I'm so relieved that you agree that the use of Tylenol suppositories are still effective in EOL cares.
Thank you Julie!
EXCELLENT JOB JULIE. So cool u had words beside u with ned names to be extra clear.
This was great. Thank you for explaining all these meds.
I’m wondering how they are controlled so no one steals ? Is a nurse there 24/7 ?
My mom died on hospice six months to the day. Morphine used day before actual death. Ativan etc before that. She went fast and comfortable My Dad was in comfort care for six days before he passed in his sleep. The day before he spent entire day with me and my daughters and grandchild. It was lovely. Passed when we left him. My sister passed used MAID in Colorado two years ago. Entire family gone in three years. So sad 🙏🏻
This had created a huge void for you. 🙁💕
Thank you for the information
Thank you for this.
Excellent explanation and information...thank you
Thank you!
My husband died in August 2023. He never wanted to go on hospice but the Dr said that was the only option. He was on hospice less than a week before he passed. I still haven’t gotten over the guilt of him being on hospice. I feel like it did make him die faster. I just hope he wasn’t in any pain. The night before he passed he was constantly taking his oxygen off and we had to put it back on. While he was on hospice he was always checking his O2 saturation. Nine months later I still can’t get over everything. Thanks for your video❤️
Hi nurse Julie, I take Methadone for chronic pain, does hospice ever use this medication for pain?
And thank you so much for what you are doing!
Yes! We do! Especially if someone has already been on it. We don't use it often bc it's tough to titrate, but we definitely do you use it sometimes
@@hospicenursejulie yes I take it every day , once in the morning and once at night.. I've been taking this medication along with other pain meds for about 25 years now..
@carolemantha8958
I take methadone too and im terrified of someone yanking it because they.believe im "comfortable" and dont need it because im out of it. I dont want to be thrown into withdrawal and not be able to tell anyone so am forced to suffer.
My late father had a feeding tube.. 19 months.
On Oxygen
A trek .. his last 19 months .. was horrible
A Self Made Man with an infectious laugh
Couldn’t Laugh
Couldn’t speak
Couldn’t Eat
My mother would crush.. whatever & put in his tube ..
Cleaned out his trek.. in the throat
This was his 2nd bout w/esophageal cancer
IT SUCKED SO BADD WATCHING HIM DETERIORATE @78 yrs old.!!!
🙏🏼🩵🙏🏼🩵🙏🏼
Then 2- months later .. my one & only brother Passed .. both gone
My 2- main Go Too Men Gone in a NY MINIT🙏🏼🙏🏼
Have you done an episode on what happens to a person who has the "drink". Not just to their body but the difference between natural and what the person would feel.
I only hope that when my time comes that there are people who will make me as comfortable as I can possibly be, and if it hastens my end, so be it so long as I’m not scared and comfortable❤
Thanks for this very informative video. ❤
My 85 yo MIL is on hospice in our home being cared for by my wife. MIL just fights and rebels against anything being done for her. She's all there in her mind, but it's her body giving out on her. She kept insisting there's something they can do to fix her inability to consistently keep food down. So hospice nurse lowered the boom and told her she's dying but her mind refuses to accept it. Assured her she will be kept pain free and comfortable. This has been a 7 month ordeal so far and it seems as though the end may be not far off. She's gotten very thin from weight loss due to nausea and vomiting. She's got cancer somewhere probably stomach related. Starrted 2 years ago ovarian cancer.
Morphine can Stop Your Breath if You Take or Give Too Much..A Mother Begged me to Give her the Full Bottle of Roxinol to Give to Her son, to End His Suffering from a Comatic State he was in From Mad Cow Disease. I felt so sorry for Her Having to Watch her 35 year old Son Lay there and Suffer, but He was only Ordered so much, Sublingually every hr to control Pain. Your Video's are Great, Thanks!
I wish hospice had told ne about Tylenol suppository cause that was mums choice for pain throughout her life. She hated anything that could make her drowsy and would refuse strong pain meds. I used Ativan for the longest recommended by Hospice to use it. When i asked for additional medicine just in case she could feel pain they prescribed oxycodone along with the Ativan.
This may be an odd question but what is the other opinion if someone is allergic to Morphine?
There are many options. Fentynal patches or lollipops, other pill forms of opiods which are not morphine based.
@@wcoasttigger TY
I have experienced air hunger and if it can be avoided it is such a blessing. It is anxiety producing and ver tiring
This was so informative!
I recently went through 3 months of hospice with my mom. Not sure how we would have gotten through the process without the comfort meds. I am concerned about this same journey with my dad who has Parkinson’s and is also allergic to morphine! How are the comfort meds adjusted for those with allergies and those who cannot take anti-psychotic drugs?
My mom is also in this predicament. Nurse Julie, any chance you could address this, as maybe Part 2 or as a separate video?
@@sillylilysallykaye4917. I am on hospice and nobody offered me the comfort kit and I have no pain medicine and I have stage four non-small cell lung cancer metastasize to the other side of my lung. How come I didn’t get any pain medicine
My husband was on Methadone !
Thank you
God bless you friend❤️🌞🙏✝️
My Mother is on Hospice as I type this 🙏