hospice

Hi and welcome. I'm a nephrology APN and I have several hospice pts that have hospice as part of a cancer diagnosis but choose to continue dialysis. I do nothing different - I still care for them the same way. The only thing is they do become a DNR and I make sure and discuss what would happen if their heart stopped on HD or they became apneic. Prior to Rx'ing them with meds though I do discuss the care with the pt. Do they want antibiotics? Do they want Vit D? Do they want epo? I go from there. Is this the info you wanted?

Dialysis can be considered a comfort measure for a hospice pt rather than a life-saving treatment. The hospice pt's we have had in the past are given tx the same as they had before being admitted to hospice. When it is getting close to the end, they usually become pretty weak & come when they can or may not come at all for some tx. We don't tell them to come for every tx like we would for someone else.

I had a home hospice patient who stopped dialysis. It was very sad-and his wife begged him to go to dialysis every day. The health team thought he would have expired within 5-7 days, he lasted 2 weeks. I was with him every day during his last two weeks - except one. I was with him at the time of death. I think the patient had just become tired. The dialysis team at his clinic were actualy afraid that if he had had another dialysis treatment he may have not survived it. I think the patient just knew it was his time, was ready and wanted to go his way. His last two weeks he compacted twice, had multiple problems with gas. His last 3-4 days you could see the blood started to settle in different areas most noteably loose skin on his upper arms. All other symtoms were pretty much basic text book. He did eat and drink apprx 7 hours prior to death. It was very sad and I cursed God on my way home.

In my practice I have had several pts stop dialysis. We always involve hospice and the pts die peacefully - at least that is what family members have said to me.

i've had dozens and dozens of esrd hospice pts.
99%+ of the time, it is a very peaceful death, with symptoms readily managed.
chief complaint is overwhelming fatigue, and almost always results in sleeping, obtunded, coma, death.
again, very peaceful.

leslie

I must say - I realy don't know what to say. I was taught period not to ever say - or be judgemental - or to view another persons situation or thoughts because in fact unless I had been in the same situation I would not be able to understand. I was given thoose words of wisdom from my teachers.
The words of wisdom from my teachers - mentors and everyone that has truely made me a better person does not change me into a person that I care less or feel less. I get angry - with friends I express myself unwisely. When I relect - the best thing about this job is being able to be real. Giving it your most and also being able at the end being able to be yourself and live.
Crazy Yes - real Yes - Peace _ Yes - we are what we are. God bless you.
By the way I am not of or do I participate in _____________the typical norm organized religion.