watching my pt. die - page 2

i am struggling and even starting to lose sleep over the following. a couple of weeks ago, one of my pts. had a cva and lost her ability to swallow. she was receiving ivf until her niece decided to... Read More

  1. by   leslie :-D
    Quote from Agnus
    It sounds like no one is helping THE Daughter. This is the source of the problem. Is it not? The daughter I mean.

    If you are a hospice nures as you state then why is the daughter not given the help, education, and support needed to make this discision?

    You are assuming that she is suffering in some way because she is awake. Awake does not = cognition. You assume. Do you really dare do this?

    You "want her snowed" but can't justify it. This should be telling you something.

    You are clearly in emoational distress. Perhaps you need to excuse yourself from this case until you can resolve your own issues. Otherwise start focusing on the daughter's needs and concerns and help her with the decision.
    the niece was never considered an rp; it was the pt. who made decisions for herself. but because the niece's phone number was in the chart as the person to be id'd, the md called her. the pt. clearly made it obvious she did not want a fdg. tube. but as i also stated, since she does have some dx'd dementia, she has also stated she does not want to die. the niece has not been involved in my pt's life and clearly does not want to be. because the pt. has also stated she does not want to die, sev'l nurses and myself are having a difficult time watching her, yes agnus, assuming that she doesn't want to die. she's ambivalent. and cognitively impaired. the niece does not want help; she wants no part of it. yesterday my patient went into severe respirataory distress as well as afib; now she's less responsive.
  2. by   Shed13911
    What a difficult position you have been in with your patient. You have done a wonderful job in trying to advocate for your patient since she can not speak for herself. You are trying to make this impending death less traumatic on this patient as poss. It is sad that the niece was involved because obviously, she did not want to make those kind of decisions.
    All of us need to think about who would speak for us if we were unable to speak for ourselves. If we do not let our families know what our wishes would be if something happens, they are just guessing at what to do for us. That is a very hard position to be in! There are also "living wills" that can be filled out and kept with our medical records so that those wishes can be communicated to the medical staff. That is a sort of safety net for those who choose to make those decisions while we are well and thinking clearly!

    I pray that the end comes peacefully and quickly for this lady. She too may wish it be over soon. Please keep us posted.
  3. by   Heartattaq
    If the lady is able to answer yes and no questions as you indicated when she was asked if she wanted a FDG. tube are you able to ask her yes and no questions that could help justify the use of the morphine?

    Some people do suffer emotional pain but some come to a peace with the position they are in (like my father did) and don't want anything that would alter their mental status. My father for instance wanted to be able to experience as much of his family as he could his last days, and knew what the Morphine did to him mentally so only agreed to Morphine when he was in considerable physical pain, and would only take Tylenol for when he spiked a fever.

    So I don't know what kind of mental state your pt. is now in but maybe some yes/No questions can be asked to find out.
    Last edit by Heartattaq on Mar 18, '04
  4. by   WalkingInTheRain
    [B]I'm sorry to hear that and hope she gets better. Just hang in there
  5. by   DixieGirl_81
    Hello,

    I'm still a nursing student and I would not know what to do in this situation, but I would like to say best wishes with your decisions and I hope that all goes well.
  6. by   bukko
    I've seen a score of patients die during my nursing career, including several on hospice assignments. Many of them were mentally ready for death. People get worn down by the struggle of years of ill health. Remember Erickson's stages of life from nursing school? Some lucky (if you can label anything "lucky" while dying) patients reach a resolution about the terms of their existence. They're not scared of whatever comes next.
    What you can do to help this patient is mouth care, number one. Being NPO is a dry way to go. Work on the person with Toothettes. Reposition them. Put their feet on a pillow. Wipe their face with a cool washcloth. It's that human touch -- literally -- that makes nursing care special.
    And talk. Not inane stuff, but about what's happening in the world, in your life, about any other people the patient might have known... If you know anything about the patient's life, where they grew up, what work they did -- talk about that. Even though the person is aphasic, it will make them feel like someone regards them as a human, not just "the CVA in room whatever."
    In short, think of what you'd like people to do with you if you were in a bed waiting out the clock. Don't snow them with morphine or Ativan. Why should the patient die in a fog, unless they're in obvious pain or fear? That might leave you feeling guilty, like you hastened the time when the poor soul stopped breathing.
  7. by   leslie :-D
    Quote from bukko
    I've seen a score of patients die during my nursing career, including several on hospice assignments. Many of them were mentally ready for death. People get worn down by the struggle of years of ill health. Remember Erickson's stages of life from nursing school? Some lucky (if you can label anything "lucky" while dying) patients reach a resolution about the terms of their existence. They're not scared of whatever comes next.
    What you can do to help this patient is mouth care, number one. Being NPO is a dry way to go. Work on the person with Toothettes. Reposition them. Put their feet on a pillow. Wipe their face with a cool washcloth. It's that human touch -- literally -- that makes nursing care special.
    And talk. Not inane stuff, but about what's happening in the world, in your life, about any other people the patient might have known... If you know anything about the patient's life, where they grew up, what work they did -- talk about that. Even though the person is aphasic, it will make them feel like someone regards them as a human, not just "the CVA in room whatever."
    In short, think of what you'd like people to do with you if you were in a bed waiting out the clock. Don't snow them with morphine or Ativan. Why should the patient die in a fog, unless they're in obvious pain or fear? That might leave you feeling guilty, like you hastened the time when the poor soul stopped breathing.
    what a lovely, sensitive response. the problem i've been struggling with is there is NOTHING obvious re: her fear. physical pain is much easier to assess. this lady has always had a flat affect and has been clinically depressed. when she initially had this cva, her speech was extremely slurred and slow but still able to answer questions w/1 word. it was at that time we would ask if she wanted a fdg. tube which she responded "no". then we'd asked if she wanted to die, again responding "no". she has been totally non verbal for at least a week now. i think after yesterday's acute episode of resp. distress with an ap of 180, i threw on the o2, gave her mso4 and a duoneb rx; and stayed with her until the respirations and hr came down. i am now certain i don't want to snow her but because i don't know what she's thinking, i feel as a nurse i have to assume the worst and give her what she might need. i've had dozens of hospice pts. that were ready to die and wanted to remain alert. thank God, she's so much less alert today.
  8. by   LesJenRN
    Quote from earle58
    what a lovely, sensitive response. the problem i've been struggling with is there is NOTHING obvious re: her fear. physical pain is much easier to assess. this lady has always had a flat affect and has been clinically depressed. when she initially had this cva, her speech was extremely slurred and slow but still able to answer questions w/1 word. it was at that time we would ask if she wanted a fdg. tube which she responded "no". then we'd asked if she wanted to die, again responding "no". she has been totally non verbal for at least a week now. i think after yesterday's acute episode of resp. distress with an ap of 180, i threw on the o2, gave her mso4 and a duoneb rx; and stayed with her until the respirations and hr came down. i am now certain i don't want to snow her but because i don't know what she's thinking, i feel as a nurse i have to assume the worst and give her what she might need. i've had dozens of hospice pts. that were ready to die and wanted to remain alert. thank God, she's so much less alert today.
    It sounds as if she might be making her own decision. Is her Afib what caused her cva in the first place? Or are her issues more on the respiratory side which lead to the afib? Is she tolerating her feeding and is it enough to sustain her? One can always hope electrolytes or rising co2 will take someone away gently. You sound caring, I am sure you are doing a fine job caring for her. Shouldnt you be sleeping by now....?
  9. by   leslie :-D
    Quote from LesJenRN
    It sounds as if she might be making her own decision. Is her Afib what caused her cva in the first place? Or are her issues more on the respiratory side which lead to the afib? Is she tolerating her feeding and is it enough to sustain her? One can always hope electrolytes or rising co2 will take someone away gently. You sound caring, I am sure you are doing a fine job caring for her. Shouldnt you be sleeping by now....?
    i don't know what time it was when you wrote this but now it's 2:06 am and yep, still bright-eyed..... there's a lot of stuff that has happened at work and is definitely taking its' toll on me. anyway les, she's not being fed; she's npo and dying. i think it was her frequent non-compliance w/taking her meds that caused this. she doesn't have any hx of resp but does have afib, htn. whatever the cause of this episode, it was abrupt onset but controllable. she definitely was struggling though....now i do see evident indications on the mso4 being given. good night and pleasant dreams.

close