Commonplace to starve someone to death?

Nurses General Nursing

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I'm a new nurse (I've only been practicing for 2 months now) and am working at a LTC facility. Today, a resident came back from the hospital, and I was told that they were strictly NPO, and that the only thing they were allowed to have was PRN morphine and ativan?!? No water, no ice chips, etc. The woman had a blood clot to her brain last Thursday (and a seizure as a result) and apparently her family signed an order for a DNR... She's still responsive to pain, will look at you when you say her name, and even tears up on occasion. I feel HORRIBLE about not being able to give her anything but 3cc's of liquid meds on my shift. Is this common practice to starve someone to death? I don't want to go against Dr's orders and give her something to drink, but every fiber in my body says I'm supposed to help her, even if she's dying, and to make her as comfortable as possible.

Any help/similar stories would be appreciated. I'm having a very hard time coping with this. :crying2:

Specializes in cardiac/critical care/ informatics.

When Patients are dying they aren't hungry. They don't feel the hunger. So you don't need to feel bad. It is about starving.

this woman needs a swallowing eval, stating her capabilities and limitations.

if she had a stroke, then yes, dysphagia would be a major consideration.

and she's a dnr, not comfort measures, correct?

yet, if she is truly unable to swallow, then yes, a decision about fdg tube vs no fdg tubes, would be the next major decision.

if she is mentally competent, it is her right to decide.

if her poa/hcp says no fdg tube, then this would go way beyond a dnr, and should be comfort measures.

you may consider contacting the ombudsmen, whose number should be in public view with the name and contact info.

but before doing so, please get all your facts together.

if she didn't have a swallowing eval in the hospital, get one done asap.

let us know what happens?

leslie

When Patients are dying they aren't hungry. They don't feel the hunger. So you don't need to feel bad. It is about starving.

that's what i wasn't sure of- if she was really dying...

leslise

Specializes in Nursing Home ,Dementia Care,Neurology..

There has been research done that showed it was more humane to not hydrate someone when they are dying.Personally i always try to give a little moisture to keep their mouths from drying and cracking.quite often they will suck the sponges we use for oral care and take in a little fluid this way.

I agree with above poster. When someone is at the end-stage of life, keeping their lips moist and giving good oral care with swabs is more comfort than actual water sometimes. If the doctor said NPO it might be that they are worried of her aspirating large amounts of fluid which could cause her more discomfort. I just recently had one of my patients die and I attempted to give her fluids which she started coughing on. I automatically stopped fluids except the small amount from the sponge she would suck on during oral care. She died peacefully 2 days later. Dying patients never get easier, you just get better at making them more comfortable.

Specializes in ICU/ER.

I have seen many patients who were NPO/DNR. Due to the stroke, I would NOT give her water...choking hurts. I would though keep her mouth moist with a sponge sticks with just plain cold water--not the lemon ones- I think they are too strong tasting , or a damp wash cloth. I would also give her saline for her eyes if her eyes are dry. Maybe even a warm damp washcloth over her eyes. I would keep vasaline/petroleum jelly on her lips.

Keep her as comfortable as possible with the IV pain meds. Re-position her frequently and keep her sheets wrinkle free. Keep her warm and dry and as comfortable as possible.

Another thing, I always talk to my dying patients, let them know every step I am doing and why. "Suzy--I am going to put this wash cloth over your eyes, it will make them feel better" "Suzy, let me scooch you over to the other side so you can look out the window".

I know it is hard for you to watch, but you will feel good knowing you made her final days as comfortable as possible.

Specializes in Med/Surge, Psych, LTC, Home Health.

Wonderful replies to the original post. I work on an oncology floor now and am learning a lot more about caring for dying patients. It IS difficult sometimes to know what to do....

Specializes in Developmental Disabilities, LTC.

I worked at a facility with a lot of terminal folks & I was also very surprised the 1st time I learned we were letting a resident go simply by stopping her tube feedings.

I asked a nurse on the floor with 30+ years experience & she told me this was the routine way of providing end of life care & that it was actually very humane. Just like a couple other posters, she told me that after awhile, hunger pangs disappear.

I thought about it & it kinda reminded me of how every once in awhile, I would completely forget a grab a meal throughout the day. If you've ever gone a whole day without a meal, you know what I'm talking about. Your tummy starts to growl for a while & maybe you'll get a few hunger pangs, but after awhile, you just don't feel hungry. The nurse I was working with told me this was similar to what the patient was going through & she said yes - your body just "forgets" that it needs food & stops reminding you to feed it.

We always provided lots of oral hygiene, though, with lots of lip moisturizers.

Specializes in Med Surg, Hospice.

I always talk to my dying patients while providing care too. I figure since the hearing is the last sense to go, the least I can do is tell them what I'm doing ("I'm going to give you a bath now, I'm just emptying your catheter") and I always thank them for letting me do what I have to do.

Thank you all for your replies. This has just been very hard for me, being new at this. I have a tendancy to try and put myself in their (the person I'm caring for) position, and when I do, its very emotional. I want them to be as comfortable as possible, and completely cutting out fluids seems so contradictory to me.

So, I take it that great mouth care is the best route to go? I want to make her last days as peaceful as possible.

and she's a dnr, not comfort measures, correct?

They sent her back from the hospital as comfort measures only. I don't understand why. And why wouldn't 'comfort measures' include giving them water/ice chips? Don't their mouths get parched?

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