[Julielpn]

LTC resident. Peg tube feed. Totally NPO. Has been for years.
Is now going through some rough times with hip. Not broken, but has had a replacement put in a few years back, started having pain a couple of months ago, we find out the hip trochanter is necrotic. Dr can't do anything. Something else came up, and dr went back in. This time, for reasons I don't understand, res wasn't "sewn up" this time. Open wound, for us to pack qod. Ok, well res continues to get worse. Now has a picc line which is supposed to receive gentamycin. Since res is having trouble recouping from all this, family has decided (with dr's ok) to dc all meds (except morphine) and all nutrition (Jevity bolus 6xd).
Day shift nurse calls dr to tell him that we all feel very uncomfortable doing this and would he please reconsider. DON calls res son (POA) and talks to him. Now the order stands that the Jevity and morphiine will continue, but all other meds are DC'd. Res had a fever of 103.5 yesterday AM. Last night, it was down to 100.5
Now, my question being. If the res is alert, can he/she not answer for themselves? Can't she decide for herself if she wants to die? What about "comfort measures"? Isn't Tylenol for a fever a "comfort measure"? Hospice is not involved, but I sure wish they were. Wonder if they are just waiting for sepsis to set in?
Is there anything I, as a LPN, can do to help her? Or is it all left up to the POA?
This situation is absolutely rediculous to me. *sigh* I feel so helpless.

[P_RN]

Would the DON/family be receptive to Hospice? That would be the way to go. My MIL is in a similar state. She had a living will that stated no tube feeding. My SIL over rode that with the doctor. So for 2 years she has been just lying there, staring out.

There are worse ways than dehydration to die, and it seems your lady is having a terrible time.

[Julielpn]

I don't really know the whole situation with the family and all, since I work 7p-7a, but it just seems awful to me!
I haven't even been a nurse for a year yet and this is the first time I have seen a case such as this.
I have read though that the longer a person is hungry, the less hungry the stomach feels, and the less pain they feel. Is this true?

[P_RN]

I believe that's true. My MIL was such a vital vibrant lady. Evne into her late 70s she would go to the council on aging feeding site and help feed the "old people," It is so painful to see her like this. BUT the daughter has the POA.....

[Julielpn]

She gets 15mg of morphine with each bolus feeding...
So in other words, even if you have a "living will" or something else that says you don't want to be kept alive (or DO want to be kept alive), it's worth spit if your POA feels differently?

I'm sorry about your MIL.... {{{HUGS}}} to you and family, and especially to her....

[CraftyLPN]

Just a question... wouldn't starving the pt be considered a form of abuse?
I have worked w/ some wonderful DON's and they do anything in their power to make sure their pts are not suffering in any way...
P_rn.. I think I remember one of my instructors saying that when I was in school...but it doesn't make me feel any better about the situation....
One would almost think that your behind is on the line .....????

[love4neos]

I am a hospice nurse, and it sounds like this patient is the perfect candidate for hospice services. Not knowing what kind of shape the patient is in, I don't have much to say. We do have quite a few patients (usually E/S dementia) when fdings that were going through a PEG are d/c'd all together. If the patient is comatosed I believe we are being more ethical to let them die, than to let them get sores all over their bodies and lay in a bed for years. That is NO quality of life. With old age and E/S diseases, hunger is no longer a feeling & there is no sensation for thirst other than a dry mouth, which can be taken care of with sponges. Look at the Hospice Nursing Board here, and look at the posts under the thread "Ethics??" it may be enlightening. I had a very hard time with this also, when I became a hospice nrs.

[jemb]

I reread you posts several times and still am not sure if this resident is actually alert, or if she at some time agreed to have the PEG placed.

If the son has POA for health care (DPOAHC) and is not following the resident's documented wishes, the dr and social worker -- and possibly ombudsman -- need to be informed of this. If, however, the son has just assumed POA because he is next of kin, he doesn't have authority to override the resident's officially documented wishes regarding her health care (or lack of it).

I agree that hospice could make the situation easier for everyone involved.

[ceecel.dee]

Originally posted by Julielpn

So in other words, even if you have a "living will" or something else that says you don't want to be kept alive (or DO want to be kept alive), it's worth spit if your POA feels differently?

Yep!

[USA987]

I just did some research on this for ethics...

http://www.nursingworld.org/readroom...ics/etnutr.htm