4 Facts You Need to Know about Morphine as a Hospice Caregiver

4 Facts You Need to Know about Morphine as a Hospice Caregiver

Morphine is one of the most commonly prescribed pain medications for hospice and end-of-life patients.

As a hospice caregiver, you will be involved in administering pain medication and monitoring their effectiveness. If the patient you are caring for is prescribed morphine, then here are 4 facts you need to keep in mind.

Morphine can cause constipation

Morphine is a pain medication known as an opioid analgesic. It works by binding to receptors throughout the body to prevent pain signals from being transmitted.

These receptors are found in our central nervous system- our brain and spinal cord- and in our digestive tract.

It is for this reason that patients who receive morphine have an increased risk for constipation.

Ideally, a patient who is on morphine will also have a bowel regimen. This may include an oral stool softener (such as docusate sodium) if the patient can still swallow pills. If a patient cannot take pills by mouth, then a suppository may need to be administered. Be sure to consult your hospice care team to ensure the right medication is given via the right route.

To prevent constipation, you can encourage the patient to drink fluids frequently throughout the day. Also, encourage the consumption of fibrous foods if they can be tolerated.

You can also give the patient prune juice or hot lemon water in the morning or at night to stimulate bowel activity.

Encourage the patient to engage in as much physical activity as they are able.

Morphine may cause increased drowsiness for the first 24-72 hours

When a patient is initially given morphine they may experience a short period of time in which they experience increased drowsiness. They may require more rest throughout the day and sleep longer at night. They may seem drowsy or “loopy”. This is normal and will subside after 24-72 hours.

After the 24-72 hours they will return to their baseline. If after a week the patient is still not back to their normal, then your hospice care team should be notified.

It is important to educate the patient on the risk for increased drowsiness and ensure they do not engage in any activities that could cause them to be injured. Activities such as cooking, climbing stairs, and driving should be avoided during times of extreme drowsiness.

Encourage the patient to rest when needed and reassure them they are experiencing a normal but temporary side effect.

Morphine can also be used in management of shortness of breath

Morphine is well known as a pain management medication. However, it is also useful in the management of shortness of breath.

Shortness of breath can occur in end-of-life for a multitude of reasons, so you may find yourself needing to administer morphine to help control shortness of breath.

Some individuals worry that morphine will cause respiratory depression, but if a patient is experiencing shortness of breath, morphine will bring their rapid respiratory rate close to the normal range of 12-16 breaths per minute.

When a patient starts experiencing shortness of breath, they may experience “air hunger” which can cause immense anxiety for the patient. Morphine can be incredibly effective in reducing the sensation of air hunger and the subsequent anxiety.

Morphine can cause nausea and vomiting

Morphine can cause nausea and vomiting in some patients. If this occurs, reassure the patient that after a few days the nausea and vomiting will likely disappear.

Nausea and vomiting are not considered an allergic reaction to morphine, so do not discontinue administering the medication as prescribed. However, if the nausea and vomiting is accompanied by a rash and itching, then do not administer the medication and contact your hospice care team.

There are medications such as ondansetron and promethazine that can be administered to help control nausea and vomiting. Talk with your hospice care team to see if they would like to bring one of these medications on board to help ease the transition.

If the nausea and vomiting does not resolve with medication or after a week, please alert your hospice care team as there may be another underlying cause.

As always, please contact your hospice care team if you have questions about your patient’s specific needs.