G-tubes or not- MD manipulating outcomes - page 2

Typical hypothetical situation- elderly have advance directive stating does not want tube feed. Has CVA and has not been thriving, intake poor, thickened fluid, pureed diet, lethargic, sleepy but... Read More

  1. by   renerian
    When my mother was dying of the flesh eating bacterial infection, she was septic, my sister was her health care POA and wanted everything done. Two surgeries later, vent, 8 units PRBCs, over 20 units FFP and platlets I finally talked her into letting her go and taking her off the vent. She died in less than 30 minutes. My mother did not want to be intubated no matter what and if she would have been coherent would have refused the surgery. She was dead the minute she hit the hospital door. I have also seen firsthand how families change advance directives.

    renerian
  2. by   2amigos
    Wow! What an eye-opener! Thank you all for posting such valid, heartfelt and informative information and scenarios. I am just doing my prerequisites for the Nursing program and am looking at possibly going into this field. I am shocked! I have copied all the information presented here because I KNOW that it WILL come up at one point or another. I also have three special needs children. One of my kids is 15, has Down's Syndrome, Autism and Dementia. It is really hard to get any solid information regarding her condition since it's unusual for a child to develop dementia so early. At this point her IQ is below 20 and she generally doesn't recognize us. I do know that since the dementia became an issue, she has lost the ability to feel most pain, hunger and thirst-and this was a little girl that would have eaten 24/7 if I would have let her.
    Thank you all so much for taking the time to post such wonderful information!!!!!
    Cheryl Moore
  3. by   sassynurse78
    I am glad us nurses are here to provide the family with other information so they can make an informed decision they can deal with. I to have had people with tubes, I.V's and even rehab, when they had living wills and advance directivesto not have these things. Working in this feild I see what it does to the pt. to have tubes inserted and other measures done to prolong life. It is a sad situation all around, and defiantly no winners. I usually inform pts. families first, then tell them it is up to them how to deal with the situation, they need to take into consideration the pts. wishes, but in the end they are the ones that will have to live with decisions made.
  4. by   sassynurse78
    oh one more thing: I am guilty of givng NPO pts. a drink of water when their begging for it, I can't say no if the person is in the dying process anyway.
  5. by   heffron
    --------------------------------------------------------------------------------

    I have a patient with melanoma. She's been diagnosed with it for over 3 years. This past October she had a surgery to remove several nodes which had supposedly contained the disease. After doctors made the incision, they had seen that it had spread throughout her intestines. Due to that, there was blockage developing in her intestines, and a g tube was installed.



    So now it has been installed in her for over 4 months, and things have been going smoothly. Just about 2 weeks ago, blood and waste have been pouring out of the wound. I've repeatedly tried to patch the wounds with gauss pads and tape, but fluids continue to run out of the cavity. In the past 2-3 weeks the cavity has grown from half an inch, to over an inch long. My assumption would be that with her skin expanding from the IVs and acid/wastes pouring out, could that be the reason why the wound is growing rapidly.



    Does anyone know how I could remedy this?





    thx

    Edward Heffron
  6. by   leslie :-D
    i guess i don't understand the dilemma here. when we have pts. on hospice, they don't automatically become npo. if they can tolerate fdg or drinking and that's what they want, then we do it. but never have i seen an elderly person starve to death....believe it, they don't starve. it's a natural shutting down of the body. and in response to the dehydration & 'starvation' your body releases endorphins. i had an elderly pt. who was profoundly mentally retarded and once an hmo took over her care, they automatically called her health care proxy and made her a dnh, with the np questioning the quality of this pt's life. well, let me tell you....this pt. who had been institutionalized all her life was violent and aggressive when she was admitted to our facility. after prolonged exposure to a loving and nurturing environment, she smiled like the dickens, learned to gently touch, learned to say 'i love you' and lived each day to watch her barney videos. now who was the np to say she didn't have a quality of life because she had a gtube and she was retarded? the facility had to have an inservice, with only me attending because i was furious when they made her a dnh. but on the other hand, when i see my patients slowly deteriorating and losing interest in their environment, then let nature take its' course. you just can't rubberstamp that all elderly should or shouldn't have fdg tubes. each situation is so unique.
  7. by   suzanne4
    Quote from heffron
    --------------------------------------------------------------------------------

    I have a patient with melanoma. She's been diagnosed with it for over 3 years. This past October she had a surgery to remove several nodes which had supposedly contained the disease. After doctors made the incision, they had seen that it had spread throughout her intestines. Due to that, there was blockage developing in her intestines, and a g tube was installed.



    So now it has been installed in her for over 4 months, and things have been going smoothly. Just about 2 weeks ago, blood and waste have been pouring out of the wound. I've repeatedly tried to patch the wounds with gauss pads and tape, but fluids continue to run out of the cavity. In the past 2-3 weeks the cavity has grown from half an inch, to over an inch long. My assumption would be that with her skin expanding from the IVs and acid/wastes pouring out, could that be the reason why the wound is growing rapidly.



    Does anyone know how I could remedy this?





    thx

    Edward Heffron
    So that I can understand this better, are the liquids and blood coming out from her GT site or from the wounds that were there? I
  8. by   jkaee
    Regarding the AD of the hypothetical patient, I think we need to get some more information. First off, your living will does not go into effect until you are declared terminal. If the patient isn't terminal, then in effect she could get a temporary feeding tube to see if her condition improves. Of course, I'm all for asking the resident first and abiding by their wishes, but I know from personal experience that the doctors will DO EVERYTHING if you aren't declared terminal, even if you have a living will.

    Bottom line....I don't think this was your job to ask the family, or at least not your job alone. If she's declined, then she should have had a significant change MDS completed and had a care conference with the family, where all the disciplines in the facility could have met with the family AND resident (all therapies, social work, dietary, DON). As a group they could have given the family all the info they needed to make an informed decision. And as for social services "not touching this one", that's too damn bad, it their job!

    Ugghh, what a situation! Everyone in the facility needs to get on the ball and decide what course of action to take, it's not just the nurses job to do this!
  9. by   CapeCodMermaid
    The point of an advanced care directive is to make sure the resident's wishes are carried out, right? So if the advanced care directive states NO TUBE FEED, then, unless the resident can change his/her mind, it's no tube feed.
    Luckily most of the docs where I work go along with that...a few of them even promote reasonable end of life care. We do have a dietician who is a little over zealous about bringing up tube feeds. If someone has lost weight or has a poor appetite, the first thing she wants us to do is discuss a tube feed. I think she is afraid of getting a hit from the surveyors for not bringing it up.

close