There comes a time in Stage 7 that the nose runs while eating food; then there are times when NOT eating the nose will actively drip. This clear phlegm is not being caused by anything except Alzheimer's. It is not a cold nor an allergy. Decongestants and cold remedies and allergy remedies will NOT stop the AD drip. However, it then gets to where it not only comes out the nose, but goes down the back of the throat. These drips occur in the evening and the coughing for when it drips in the throat - during the night. It is scary because it sounds like they can't cough it up, and you hope that they are still breathing in the morning because regular remedies don't work.
The Hospice nurse came today and she check with the Hospice doctor, who is sending out atropine to be used as needed in very small quantities. I went online and found out about the drug and it source, and found this article - a question by a nurse and answers by other nurses.
************* Question: There is a resident who is on Hospice and actively dying. Towards the end of my shift today, he had an extreme amount of secretions that he was unable to clear by coughing. We have an order for Atropine Eye Drops, 2 drops SL q6 hrs. However the 2nd shift nurse who was taking over was adamant about NOT using it. "You have to be extremely careful when using that". Things happen, as usual, and I was unable to ask her what she meant by that. I know that Atropine affects the CNS, but the man is dying and was uncomfortable - ie: dyspnea d/t the secretions and was becoming restlessness. I know you can't read this nurse's mind, but can you help me to understand why she was being so cautios? ************* Answers: I'm not sure why she would object to this treatment when someone is actively dying. We use atropine gtts quite a bit on our unit for acute episodes of secretions without any problems. For long-acting effect, we will apply a scopolamine patch at the first signs of increased secretions, but will use atropine gtts until the patch begins to take effect. Both of these medications have proven helpful in many cases of increased secretions. Hopefully she will clarify this for you so that we can understand what she meant.
*** Well, you do often get the rest of the anticholinergic effect with atropine-rapid heart rate,agitation. Which I mainly mention to families so that they don't over use it, I would certainly prefer those side effects than those of suctioning-every non-hospice nurse involved with a hospice patient wants to suction because we think we need to do something. I am going to tatoo "No suction" on myself! *********************************************************************************************************************************************************************
I was wondering if others of you, especially those widows and widowers, had any experiences to share on this subject. If any of you whose spice are still with you and you use it, please share.
My DH is not stage 7 but has had the constant running from his nose usually when eating and his doctor rx'd a nasal spray that works when used about an hour before meals -- when I can get him to use it. It's Ipratropium Bromide Nasal Solution.
Hospice sent atropine to the house for me to use when my husband was dying.....at the point I used it he was too far gone to experience anything...I was glad to have it because I am sure it kept his last days and hours free from the gurgling and choking that could have happened.
Weejun, I wasn't aware so many others are having this problem. Mine has, too. He explains it to himself as "allergies." Thanks, Weejun, for the name of the medication that might help this. The doctors had no explanations for it.
My husband, who was diagnosed with MCI in 2008 and with probably Alzheimer's in January 2010, has had the problem with his nose running when he eats for about 2 years. He just got a prescription for ipratroplum in November. It helps when he uses it before meals. I thought the trade name was Atrovent. The problem obviously started well before the end stage of the disease.