hospice

Trauma Columnist · Apr 20, 2009

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?

anurseadvocate · Apr 21, 2009

I was also interested in the dialysis staff and how they interact with patients e.g. do they discuss hospice, etc. what is the dialysis facility social worker's role, etc. RenalRuth I know some units techs are often not even aware of changes in medical conditions or are made aware of medical conditions when patients are discharged from a h ospital. RenalRuth

workingmomRN · Apr 21, 2009

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.

anurseadvocate · Apr 23, 2009

Wouldn't dialysis keep someone alive until their heart gave out? What is the patient decides to stop dialysis? Has anyone had FIRST HAND OBSERvATION of a patient who has stopped dialysis. RenalRuth

texastaz · Apr 24, 2009

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.

anurseadvocate · Apr 24, 2009

Thank you for sharing. I am interested in others experiences with patients as they observe after they stop dialysis.

Trauma Columnist · Apr 27, 2009

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.

leslie :-D · Apr 27, 2009

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

texastaz · Apr 27, 2009

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.

texastaz · Apr 27, 2009

Death is a fact. Time is not our choice just like birth. We do not have choices about how a person lived or how they will or when they will die. All we do is bring non judgemental treatment to a patient and focus on that patient so they do not suffer. To go further and deaper into it is beating yourself up.

Lacie, BSN, RN · Apr 27, 2009

We have frequent patients in hospice on dialysis. Some choose to stop others continue. We treat them same as any pt not in hospice. We do cpr and send them to ER even if a DNR. Our policy is that the ER and primary handle the final decisions at hospital if they should code while at the clinic. Fortunately I havent had this happen (hope I didnt jinx myself there).