Respecting patient's wishes or Neglecting patient's care?

[jetfuel]

A friend recently wrote to me about his aunt ("Mimi") who had heart valve-replacement surgery.

"Mimi" is normally a strong-willed person and very health-conscious. However, after this ten-hour procedure (originally expected to take four), she became (as my friend put it)...lazy. She refuses to eat more than a mouthful, and has yet to use the spirometer she was instructed to use every half hour.

It's like she "just quit."

The issue I bring here is that the nurses on staff there didn't say word one to encourage her to recover or even take basic care of herself. It is as if they would rather avoid any confrontation and go on to something or someone else. I'm not suggesting that they force a patient against her will, but to not even encourage her to eat?

Thoughts?

[jadelpn, LPN, EMT-B]

Any surgery that takes 10 hours would take a toll on the most healthy individual. As a nurse, we often have to figure out what is the barrier to a patient's recovery? I would have to think off the top of my head pain control. This is a tough subject for some older people as most don't "get" that they are NOT "druggies" or "addicted" by using pain meds. Some just don't want to deal with the constipation and the "loss of control" that seems to follow a pain medication regimine. Additonally, using the IS hurts like heck.

There could be many reasons why Auntie isn't eating. Is she nauseated? How long ago was the surgery? Anethesia sometimes takes quite a while to get out of an older person's system, so perhaps she is just not herself quite yet.

Make sure pain is not an issue. Set some real short term goals. Surgery such as this can make someone depressed. Especially if someone is used to being healthy. Again there's lots of stigmas attached to that for a number of patients, but especially older patients.

Family meetings are never a bad thing. Goal setting (realistic). Cardiac rehab. There's lots of choices, and other disciplines besides nursing who can get involved with this.

Best wishes!

[Orange Tree]

That sounds like a good role for the family to take on. Encouraging people to eat is not something I normally have the time to do. I'm lucky if I'm not close to passing out from skipping meals, myself.

[roser13, ASN, RN]

How old is Aunt Mimi? I sometimes find that the elderly have a rather odd (possibly old-fashioned?) idea of what happens in hospitals. She may not be of the mindset that she needs to do anything to contribute to her recovery. After all, she is a patient in the hospital - won't everyone just take care of all her needs?

If that's the case, I would think that a gentle talking-to by a family member might help or re-orient her thought processes.

[Tait, MSN, RN]

I agree with previous posters about the family getting involved. From where I see it the Incentive Spirometer is a staff task to enforce. By enforce I mean, educate in a consistent and repetitive way. I might even recruit the CNA/Tech to encourage her during vitals and the like. As far as eating I know EVERYTHING tasted weird to me for over a week after a simple gallbladder sx. Anesthesia does something weird to ones taste buds bleech. Anyway, meds aside, the family can help by bringing her reasonable foods that she likes in. I know families are often intimidated by the hospital and staff and feel they play no role, or choose to play no role in their family members care. I think it would be nice for someone to chat with the patient and the family about why she isn't eating and what can be done to encourage her.

[jadelpn, LPN, EMT-B]

Another viewpoint is that a cardiac diet is not something that someone who perhaps is used to eating salted foods, "real" fat variety food is overjoyed to experience for the first time. Things can taste bland and gross. Add that to meds and anesthesia, and can be akin to eating cardboard.

Make use of the dietician. Aunt Mimi needs to know that there is a viable option to salt, which low fat varieties are tasty, and that "Mrs. Dash" is her best friend. That and garlic, and all is well in the world.

[netglow, ASN, RN]

Aunt Mimi is within a very NORMAL range after valve surgery or any large heart surgery. Yup. It's a major hit in all aspects. Appetite might not be there at all, and the fatigue is huge for most. It's going to take a lot of time and she will likely lose a lot of weight in this whole deal. Things are not at all normal physiologically for patients after major cardiac surgery for many reasons. Gonna take months most likely to be able to function close to normal for the particular patient, and that is if the outcome is optimal.

You should understand the difference post op for these patients immediately. It would be wise to do some research on things to understand what it's all about. Information is readily available on most heart center websites.

[Morainey, BSN, RN]

My step dad had heart surgery and said afterward he felt like he'd been hit by a truck. Active guy, too.