Dying of starvation

[Missingyou, CNA]

I am having a trouble understanding the process of one of my residents.

She is 94, alert and of sound mind. She is capable of making her own decisions.

She came to our LTC facility about a month ago after suffering a stroke that left her, for the most part, unable to swallow. She was going to therapy to assist her with this problem.

She is not able to have a feeding tube because of an abdominal aortic aneurysm but, she was seemingly doing just ok with eating and drinking altho it was difficult.

About a week ago, she was admitted to the hospital for aspiration pneumonia. This did not surprise anyone because of her difficulties.

She returned to our LTC very weak. She was once an easy 1 person transfer. Now, she is bed ridden. She is also NPO now. When I asked her nurse how she gets her nutrition if she is NPO the nurse replied she is hospice, she doesn't get nurtrition at all. She will eventually die.

I am having a hard time accepting this! I know it is NOT my decision. It is really none of my business. My only place in this is to provide care for her and keep her comfortable.

She is still alert and of "sound mind". She asks me to give her a small cup of water so she can suck water from a sponge. I CAN'T do this. I remind her that I am not allowed to.

The nurse has been very clear on my not giving her ANYTHING because she can choke and die.

So, instead, I have to watch her literally die of starvation...and I watch her family all day, every day trying to cope with this.

Tell me something about this process to make it easier. I've search the internet trying to learn more about aortic aneurysm, but nothing is helping. I know it is probably a decision she and her family made, but how do you tell someone they can't have a sip of water when you know they've not had any nutrition in about 4 days.

[GrumpyRN, NP]

What about an N/G or TPN?

Without having all the details it sounds as if she is being deliberately starved.

It may be simpler - certainly faster and less distressing - to just give her some oral fluid and allow her to choke.

[loriangel14, RN]

If her mouth is dry then she needs to have adequate mouth care done. Palliative patients will not benefit from food/drink that they cannot process.

[Missingyou, CNA]

We do provide mouth care...or rather, she provides her own because she is currently able to. I give her a toothette I dipped in water or mouth wash that has been "squeezed out" and a lip balm to keep lips moist.

As far as the N/G or TPN, I asked the nurse and she just said they were not ordered for her. That's all that was offered and I didn't dare dig for more information or for reasons why. It's just really hard to watch this and to not give her even a small sip when she asks for it.

[morte, LPN, LVN]

if she is hospice, there is no reason she should have small sips to drink.....

[Paws2people]

What about small ice chips? One or two shouldn't be a problem.

[schnookimz]

If she's hospice, she should pretty have whatever the heck she wants!!!

[Ndoht, ADN, CNA, LPN, RN]

The whole point of hospice is making the patient feel as comfortable as possible and giving her whatever she wants, regardless of the consequences. The patient's wish is the top priority now, not trying to fruitlessly prolong her life when she is suffering every second of it - that simply goes against the whole concept of hospice. Why is the sign that says "No Resuscitation" placed on the doors of hospice patients? Is there only one nurse who is assigned to her? Is there a nurse manager or DON? I am not sure what setting you work at, but you can plainly report the situation to the nurse manager or DON and just see what she says about it.

[brrrr83]

The patient needs an advocate....either a family member to push the issue or someone high up at the facility. I'd talk to a manager.

[Red Kryptonite]

She is also NPO now. When I asked her nurse how she gets her nutrition if she is NPO the nurse replied she is hospice, she doesn't get nurtrition at all.

Oh. My. God. On hospice so she gets no nutrition at all? It's bad enough that the general public thinks this, but nurses? Maybe tube feeding or TPN isn't appropriate, but NPO is cruel at this point.

[Beautiful_Soul]

Honestly you need to go over that nurses head (respectfully) and talk to someone about this. IT'S her HUMAN RIGHT to have a "sip of water". If I was you not only would I REFUSE to watch that lady suffer I WOULDN'T TOLERATE IT. That's just so sad this made me cry a little. Ask another nurse why is she being denied WATER! OMG NO! So wrong

[loriangel14, RN]

Water should be fine as long as she isn't going to aspirate but TPN or tube feeding would be inappropriate.