• Grace11's Avatar

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    Grace11 asked a questionNon-Hodgkin Lymphoma (NHL)

    Roxanol at end of life

    • nancyjac's Avatar
      nancyjac

      I would assume however much was needed to manage pain.

      over 4 years ago
    • carm's Avatar
      carm

      Grace11, I am an oncology/end of life nurse and maybe I can help answer your question. Roxanol is a liquid form of morphine that is given in the pocket of the cheek ( buccal mucosa) and is absorbed thru the skin. Many think it is supposed to be swallowed but that is incorrect. Because Roxanol is a form of morphine, there is no set limit to how much is given but most end of life docs write the order in parameters like 5 to 10 mgs every hour prn. Im not sure how nurses in hospice handle the orders, but in end of life care where patients prognosis is 2 weeks or less, we are allowed to amend that order upward or downward if needed without a docs order as long as we notify the doc within a 24 hour period. I have given up to 40 mg an hour at times to get a patient under control. When you work in hospice/ end of life nursing you are protected by the law of Double Effect but using Roxanol in oncology is different. Then docs have to set the dose like 5 mg every two hours prn, no parameters. That is the policy of pain management in most hospitals. Unless the prognosis is 6 months or less, you rarely see parameters. You cannot give Roxanol thru tubing (IV push) because it adheres to the tubing. It upsets the stomach if swallowed. Keep in mind that the more the amount given the more the respiratory system is suppressed so the shallower they will breathe. You will know how much is enough by the subjective reactions. They are more relaxed, their face shows no sign of pain, no furrowing of the brow, pulse rate decreases, and their body will relax from a fetal position to a more relaxed one. I can give the parameters from every hour to every 15 minutes if necessary when death is eminent. I hope this answers your question. A normal drug order in hospice/ end of life is referred to a H.A.M. sandwich which is Haldol, Ativan, & Morphine in that same liquid form which is called an Intensol. Best of luck to you, Carm.

      over 4 years ago
  • Grace11's Avatar

    Grace11 shared an experience

    Other Care (Hospice): A hospice nurse/case manager is managing her palliative care. She has been getting 5 mg roxanol prn. That turns out to be about 2x/day. Because she is not communicating I don't know what she is feeling. She also gets ativan prn. Wondering how long she might remain in this state. Death is inevitable for her. Would like to hear from others who have been caregivers of persons with Non-Hodgkins Lymphoma and how the final days have been lived out.

    2 Comments
    • GregP_WN's Avatar
      GregP_WN

      Hi Grace, that is a hard, hard thing to do, take care of a parent in Hospice. I have done it twice. One of the hardest things in my entire life, and that includes having cancer myself 3 times. The nurses at our Hospice care were very good at being able to estimate time left. Just ask one of them what they think. They will tell you they can't tell exactly but it's usually signs that show up as the time gets close.

      Best of luck to you

      over 4 years ago
    • Nanc620's Avatar
      Nanc620

      Grace...it is so difficult. Saying prayers for your mom's comfort and for you to be comforted by your memories and her everlasting love.

      over 4 years ago
  • Grace11's Avatar

    Grace11 shared an experience

    Decision Point (Whether to continue Rituxan): Mom had 2 Rituxan treatments. When she went in for the third treatment there were a number of problems that she had. Her heart was in A-fib and they thought she might have an infection. She was hospitalized for 4 days and released to a skilled nursing facility for rehab. She had one more Rituxan treatment, but she wasn't getting better. She was supposed to have a 4th, but she wasn't well enough to have it. She has eaten very little for weeks, and almost nothing for the last 12 days. We think she is now close to death. She is not responding to us, not speaking. She is cared for in the same nursing home, supplemented by hospice.

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    Grace11 shared an experience

    Drug or Chemo Therapy (Rituxan--my mother was too old for chemotherapy. That would have been R-CHOP or CHOP-R. Instead she just had R.)

  • Grace11's Avatar

    Grace11 shared an experience

    Oh No (Diagnosed): Finding out on October 4th that my mother probably had lymphoma. Dagnosis had not been confirmed by biopsy. I was eating dinner in the Baltimore airport waiting for my flight back to Ohio.

    1 Comment
    • grandmafran's Avatar
      grandmafran

      Dear Grace,
      I know what a difficult time this is for you. I went through it with my father when we ran out of options for his prostate cancer. I also have lymphoma and had a much harder time the last go-round with Rituxan.
      I think your mom is lucky to have you. You cared enough about her to get on a support line which I think says a lot about how much you love her.
      I once read about a little boy who had leukemia and wasn't responding to treatment. His words filled my heart with awe. "Everyone lives a lifetime".
      Very profound and very comforting.

      over 4 years ago