Question for nurses

[Lackinghope]

If you are a nurse, especially if you work in a care home do you know what a volvulus is without googling?

Oxycodone and morphine are different medications, they should not really just be interchanged like that.
Everything should really be given via injection. With a volvulus, you never know if the medication is being absorbed, therefore not working. It sounds a bit of a mess @Lackinghope I would double check if they have the injectable medications. If not the care home really need to call the GP now.

In answer to your question, I wouldn’t have known. However, anything I don’t automatically know from a discharge letter for my patient I would look up to make sure I am doing the right thing, and as a pp said I learn new things all the time.

I’m so sorry about your mum, it sounds very upsetting and stressful.

Thank you, it is a mess , we struggle to get comprehensive answers from the care home nurses and I have lost faith in them. You saying that the meds shouldn't have been changed like they have been reinforces my doubts. We are considering asking if she can be moved to a hospice.

I was just thinking a hospice may be a good idea for your mum. If the palliative care team get involved however, they should be able to get your mum comfortable and settled.

At least the home are giving your mum some pain relief, whether oxycodone or morphine. I hope it all gets sorted out soon for you all.

Yes, definitely ask if your Mum has already been prescribed anticipatory medications, the nurses should know what these are, there are usually 4 different types of medication to manage symptoms that might occur, and these are usually sent home with the person from hospital. If they have the medication then ask why they aren't considering giving them ?
If they don't have the medication then they need to ring the out of hours GP who can prescribe them, ours will even provide a few vials if there is no pharmacy open, so don't assume nothing can be done today/overnight.
I really hope you can get some help soon for your poor Mum.

She should have been seen by a GP whe she was admitted, how long has she been in the carehome. It should have been a doctor who changed the medication, prescribed it and arranged for the pharmacy to have it delivered. Does it say anything on her discharge letter about what medication she was on In hospital and what she was sent to the carehome with. Maybe she did have a burning sensation with the liquid, you can ask to see her medication chart and if you get nowhere then you can call 111 yourself.

Hospitals need patient specific prescription too even if they’ve got the medication on the ward. Any changes must be made by a prescriber (some nurses can prescribe too)

I was just saying there are alternatives - the lady will need to be reviewed to see what is appropriate

Yes I know but hospitals keep stock cd, carehomes dont and are are patient specific, you need individual prescriptions so you can have 10 bottles of. Oramorph or paracetomol for instance. Thank you Dr Shipman.

This is really difficult to answer. One thing I would say....if you are noticing changes in a person by the day, quite often the person may have days left. If the person's condition is changing by the hour, then it may only be hours.

The main priorities during this time are that your mum is as comfortable as possible, and that you and your family are being supported by the care home staff. It doesn't sound like this is happening. Things don't need to wait for tomorrow, there are always out of hours services to contact for support.

Nothing about what meds she was given in hospital, says she will be discharged with crisis medication.
She's been in the home since October and was admitted to hospital just before Christmas.

The crisis medication will be the injectable medications. This is exactly what your mum needs. The nurses need to give her some pain relief, it can usually be given hourly if your mum is still in pain.

I would go and ask the nurse for the injectable pain relief and see if it works for your mum. It is not much use giving oral medication at this time.

I’m not a nurse but know what it is because my son had a bowel obstruction almost 2 years ago and it was one of the things they suspected but it was actually Intussusception.

Thank you all for the invaluable information, you've been more help in a couple of hours than the care home have in weeks. . I'll call them and ask them to give mum an injection, fingers crossed she'll agree.

If your mum has been declining injections then maybe they have prescribed antipatory medication, sometimes nurses give one two morphine injections to see if that's effective and if not move onto a syringe driver. The hospital should have given the carehome staff instructions on pain relief, earing, drinking, this is usually a ,better from either the doctor or the nurse.

Hopefully it will help, it's a small injection under the skin, she might also have anti sickness injections prescribed.

clinician here. It has resolved if she is no longer vomiting and opening her bowels. It was clearly managed conservatively.
There is no special diet afterwards, eat and drink as normal.

She is hardly eating , maybe a teaspoon of yogurt and hasn't opened bowels since discharge

Speak to your GP and / or palliative care
team for more advice.
If she is EoL this can be normal but difficult to say without the exact history.

Are they RGN,s or RMN,s ?
both can work in nursing homes ,
I used to be an RMN and dont know ,we had very little general health experience in training
And whilst we did do more physical care when I worked in Dementia care we were certainly not experts in physical health.

To add, does it really matter if the care home staff do / don’t know what Volvulus means. All that really matters is that they know how to act on her symptoms to get to acute care if needed.

This. It’s impossible to know everything, you’d like to think they’d look it up or plan to but also the place is probably crazy busy so it’s been deprioritised. Unless you’re otherwise worried about the care your mum is receiving?

She may not be for further acute care, symptom control and comfort is the priority, that is the job of the carehome nurses but agree that the vollvulus diagnosis doesn't change anything.

This
It's misleading that nurses know everything and can work anywhere because they are on a register
I'm nursing nearly 25 years.. specialising as a district nurse
I can tell you about leg ulcers / palliative care/ management of the diabetic patient
Don't have a clue about most other areas of nursing
Would be snookered if I had to do a medication round

As her family, we just want the best care for our mother , we didn't know if having a volvulus was relevant or not, if it would change her care or not and given that trying to get information from them has been difficult to say the least , I thought I'd ask on here. We're worried, upset and sad , it's so hard to watch someone slipping away.

I only answered your question quickly l didn't go into any detail because l didn't realise your situation @Lackinghope. I am so sorry you are going through this. l am going through the same with my Mum ATM .
I think we need to accept what is happening, this doesn't mean giving up on them , it means making sure than our Mum's are out of pain , as happyand as comfortable as they can possibly be and that we are there to hold their hands and to show them love throughout . It's very difficult for us to watch them essentially dying in front of our eyes but we have to be there for them and go through it with them . I have looked into
the process the body goes through and it seems that the body and mind takes over and it's a very natural process .
I wish we weren't in this situation but we are and we can do this for our darling Mums . Bless you ❤️