Congestive Heart Failure

[Monica Zilko]

Can anyone please tell we what to expect at the end of CHF - i am caring for a 75 year old lady, who i might add is lovely and knows she is dying.

She has been rated as end stage for 18 months now, but has gone down hill over the last 6 months. She is always sleeping, vomiting, and had severe SOB - she has oxgen in her house that she uses constantly. She is in so much pain (her feet and legs) uses morphone liquid and S/R tablets amongs other numerous medications. Her kidneys work off and on, has been hospitalised numerous times.

She says she knows the end is near and her doctor said that it would be a blessing if she passes in her sleeep because if she does not she will have a terrible death - can anyone elaborate on this, i just do not know what to expect.

Thank you

[leslie :-D]

sev'l links similiar to the following, are readily available.

my point is, end stage chf is not the same as the terminal phase.

especially when hepatic and renal failure sets in.

people can live w/end stage for yrs.

it is when they become totally bedridden, and comorbidities are dominating precious time left, focus should be on abating symptoms.

chf remains poorly treated, despite meds that prolong survival.

careful consideration needs to be given re what meds to continue, or not.

Dying from heart failure: lessons from palliative care

"Despite the wealth of therapeutic advances, quality of life in chronic heart failure is poor and discomfort and distress often worse than in cancer."

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1114039

leslie

[Monica Zilko]

Ok - her medications are as follows;

Ordine - as required (morphine hydrochloride)

Kapanol - 2 per day (morphine sulphate - sustained release)

Breakfast

Cartia 100mg x 1

Atacand 8mg x 2

Frusemide 40mg x 1

Eutroxig 100mg x 1

Sertraline 50mg x 1

Carzedilol 6.25mg x 1

Dinner

Carzedilol 6.25mg x 1

Bedtime

Temazipan 10mg x 2

There were meds, but dr has stopped them.

She is confined to a chair and bed.

[Monica Zilko]

I forgot to add that she is on oxygen 24/7

[leslie :-D]

Ok - her medications are as follows;

Ordine - as required (morphine hydrochloride)

Kapanol - 2 per day (morphine sulphate - sustained release)

Breakfast

Cartia 100mg x 1

Atacand 8mg x 2

Frusemide 40mg x 1

Eutroxig 100mg x 1

Sertraline 50mg x 1

Carzedilol 6.25mg x 1

Dinner

Carzedilol 6.25mg x 1

Bedtime

Temazipan 10mg x 2

There were meds, but dr has stopped them.

She is confined to a chair and bed.

ordine is not morphine.

it is an antihistamine.

she needs something for breakthrough pain.

and for n/v, constipation

and for anxiety.

leslie

[shrinky]

We have recently used nebulized Lasix since, it is not absorbed as much as oral, which might relieve some of the congestion. I agree with the use of Morphine and Ativan in this case. She most likely will need to be very sedated near the end. Good luck and thank you for all you are doing and for caring.:heartbeat

[marachne]

ordine is not morphine.

it is an antihistamine.

OK, I admit, I'd never heard of ordine, nor had I much familiarity with morphine hydrochloride -- always used MS04.

So, the internets are our friend, and I went searching. I finally found this which does link morphine hydrochloride to the brand name ordine. Therefore I have to conclude Ordine is a pain medication...but I'm willing to be set right.

It seems to be much more common in the UK and Australia. The use of the word "carer" also makes me think non-US.

[leslie :-D]

OK, I admit, I'd never heard of ordine, nor had I much familiarity with morphine hydrochloride -- always used MS04.

So, the internets are our friend, and I went searching. I finally found this which does link morphine hydrochloride to the brand name ordine. Therefore I have to conclude Ordine is a pain medication...but I'm willing to be set right.

It seems to be much more common in the UK and Australia. The use of the word "carer" also makes me think non-US.

oh my goodness...

you're right.

i don't know what i was thinking.

my apologies.

leslie:imbar

[leslie :-D]

mez, if she is still getting out of bed to a chair, then to me, it would be realistic to share your concerns about her constipation.

some may think i'm obsessing, but truly, i'm not.

addressing this can indeed, alleviate some if not much of her pain.

if she is complaining of breathlessness, air hunger, she needs to have her morphine increased.

and getting her some ativan or something for anxiety, will also be of tremendous value.

i need to believe her hospice nurses know this?

and, you are a very special person to be so concerned.

thank you.

leslie

[marachne]

no apologies necessary! I know I get confused between generic names and brand names often (example, I'm so used to saying quetiapine that the first time someone started talking about seroquel I didn't know what he was referring to). And then you get the brand names that are different in different countries -- chaos ensues!

[marachne]

How is this for timely? Also, just in general, I recommend this site -- really knowledgeable, nice guys (one's an NP), always nice to have someone do the "digesting" for you, then you can follow up with articles that seem particularly useful. It does lean someone towards the palliative care/hospital side of things, but I often find good info. And their new "arts & literature" and "case studies" sites are good too.

[Monica Zilko]

Thank you to all you wonderful people out there who have answered some of my questions.

I am from Australia, and know names of some medication differ across the glode, and just to clarify, i am not a nurse, just a carer/companion who is concerned over a wonderful lady.

This is the second time i have had to care for a terminally ill pt - and i must admit, i have become very involved and it will break my heart when she passes. I am a better person for knowing this lady - she has tought me so much about life and what really matters. Each and every nurse and Dr that sees her say the same - that she is a very special lady.

Her morphine has just been increased and she does take Sertraline which is an anti anxiety med, she also has medication for constipation.

A bit of medical history - this lady had a triple heart bypass Sept 06, then had heart attack which caused large pseudoaneurysm, had surgery for that March 07, which failed, was in ICU for 10 day, kidneys failed - everything that could go wrong did, but she came around, Dr's said she would not live past 3 months - here we are 15 months later and she is still fighting.

She does say now it is almost time and she is too tired to fight anymore and just wants to go - she hates the thought that she is a burden to her family - her family are very loving and caring.

I am so glad i found this place, and if you all don't mind will keep writting keeping you up to date with how things are going - i am sure that we all can help this lady stay as comfortable as possible.

By the way - i asked the nurse if enemas are ever used to relieve constipation, she is going to talk to the Dr.

Thank you again.

Mez

[marachne]

i am from australia, and know names of some medication differ across the glode, and just to clarify, i am not a nurse, just a carer/companion who is concerned over a wonderful lady.

not surprising then that i found ordine on an oz site.

this is the second time i have had to care for a terminally ill pt - and i must admit, i have become very involved and it will break my heart when she passes. i am a better person for knowing this lady - she has tought me so much about life and what really matters. each and every nurse and dr that sees her say the same - that she is a very special lady.

i'm glad you've made such a strong connection, but be sure you also do self-care: let yourself honor your bond and your sadness, but figure out ways to also give yourself time and space. boundaries are an issue in any kind of nursing care, but eol is particularly susceptible--you often become closer to people who are vulnerable in open in ways not common in other settings, and the boundaries become blurred. remember you're not the only one following her and share the burden

[snip]

she does say now it is almost time and she is too tired to fight anymore and just wants to go - she hates the thought that she is a burden to her family - her family are very loving and caring.

i'm curious, does she live with family? how involved are they? again, if you're at all worried about your role/boundaries look at your relationships w/the family. also, for you lady, and her concerns about being a burden, you can remind her that for many people, it is a wonderful gift to be given the opportunity to care for someone who they love. often the concerns about being a burden are not reflected in the experiences of the people providing care.

i am so glad i found this place, and if you all don't mind will keep writting keeping you up to date with how things are going - i am sure that we all can help this lady stay as comfortable as possible.

that sounds like a good thing -- and gives you a place for support.

by the way - i asked the nurse if enemas are ever used to relieve constipation, she is going to talk to the dr.

thank you again.

mez

one other thing: you asked what you can do as her carer -- you can be the eyes and ears (and nose!) of your client, as well as her advocate -- share anything w/the nurse and dr that you think is relevant -- you're with her a lot more than they are, and while they have professional and technical knowledge, you have the day-to-day experiences. let them know your concerns, but, as someone else said, allow that they may do things differently than seems "common sense" for a reason. however, if you see adverse reactions to tx decisions they make, let them know.

good luck, you sound like a very caring, compassionate person!