Sunsilver
Isn't it incredibly important for people who suffered a stroke to get all possible care quickly?
Y'know, I read all this WONDERFUL stuff in my nursing texts about these clotbusting drugs that can actually dissolve clots, but which must be given within a specific time frame in order to do any good... but they don't seem to use them here in Canada!
They never gave my husband these drugs.... despite all evidence to the contrary, the doctor seemed to think he'd possibly had a hemmorhagic stroke, (caused by a ruptured blood vessel) rather than an ischemic one (caused by a clot).
Same thing in mom's case, though with her blood vessels being so fragile, I do not think it would have been a good idea to give her one of these drugs.
If you're not administering a drug such as streptokinase, you can wait as long as you want. About all the hospital can do is do a scan to show yes, you DID have a stroke, and put you on IV fluids to keep you hydrated until they can decide if it's safe for you to have food and fluids by mouth.
Re: Laureanna's post: Laureanna, I've given morphine to help ease the dying of cancer patients, and another very elderly patient with a septic leg, who was very, very terminal, and in agony. By that point, you don't even ask yourself if this might push them over the edge. You just know you have to do something to relieve their suffering.
That one case haunts me still. She was in her late 80's, had diabetes and Parkinson's disease. Her leg had gone septic due to the diabetes, but they did not want to amputate it, because she was in such very poor health that she probably would not have survived the surgery. So, they just left things alone. Yes, she did get antibiotics to fight the infection, but there wasn't enough blood circulation left in the leg for them to be able to eliminate the infection. Essentially, it was a piece of dead meat.
We kept hoping she'd slip peacefully away, but that last night, I got a call from the daughter, asking me to come. She was conscious, aware, and in pain. She also seemed to be fighting for breath.
The doctor had left orders for the morphine drip to be titrated, so, as soon as I got there, I increased it. While waiting to see if that was enough to bring relief, I called the doctor on call, and got an order for Ativan, which is a big help in relaxing people who are in respiratory distress. (This was very stressful...I had trouble getting through to him, and when I did get him on the line, he was reluctant to do anything, in case it killed the patient....ummm....excuse me, isn't she SUPPOSED to be dying??
)
Anyway, when I finally got the order, and returned to the bedroom, the patient was a little bit more relaxed, but when we asked her, she told us she was still in pain. So, I increased the morphine dose one more step. I then tackled the dressing change on that horrible mess of a leg, doing only what was absolutely necessary, to spare her as much pain as I could. By the time everything was tidied up, and my charting done, she was drifting off to sleep. The daughter and I stood in the darkened room, and had a brief prayer together, then I went home.
The next morning, I was told she'd passed peacefully away around 3 am, while the daughter sat at her bedside, reading the Bible to her. The daughter was so grateful for what I'd done, that she had called both my supervisor, and the government case manager to tell them what a wonderful nurse I was.
I heave a big sigh of relief, because I'd been really frightened of doing something wrong, and that someone was going to complain.