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

[Monica Zilko]

This lady lives alone - her husband passed from alzhiemers several years ago.

There are four adult children, 2 boys and 2 girls all married with kids of their own. They are very supportive and always visit (i am sure they have a roster going) no sooner does one leave then another one arrives - this lady is rarely on her own.

The Dr referred her to hospice, but she refused so thats why she is having palliative at home - then her children offered to have her move in with them, she also refused, so they said they will move in with her - but you guessed it, no. She is very independant, even now, but you can see that she loves it when the kids are with her.

The children are very loving and supportive, always lookiing for ways of helping. The two daughters prepare all her meals do her washing, dhopping etc - they are a very close family.

All the kids live within 5-10 minutes of thier mother. Even the grand kids help out.

Mez

[leslie :-D]

sertraline is an antidepressant that contains antianxiety properties.

i'm glad she's getting that.

however, i would suggest an anxiolytic which would be much more effective.

we always give meds for anxiety, along with the morphine, dilaudid, whatever the pt is getting for pain.

there is a lot of anxiety in dying...

suppositories and enemas are certainly not first-line agents, nor are they used frequently.

most times, we have to titrate laxatives up to a dose that works...

and even then, sometimes nothing does.

i've had pts who have actually stopped taking their narcotics, just so they could have a bm.

that's how painful it can be.

i frequently need to digitally disimpact them.

sometimes this has wonderful results:

other times, the pt is only partially evacuated.

mez, your pt is so very lucky to have someone like you by her side.

come here anytime.

you're a pleasure.

leslie

[Monica Zilko]

Update on my lovely lady....

She now has blisters on her legs, Silver Chain is calling in Clinical nurse to assess her today. Nurse said time is going to be sooner rather than later and will be talking to the family about having her admitted to hospice. I know this lady wants to pass away at home.

Her family are willing to stay around the clock to help and just be with her.

In your opinion, what would be the best advise to give - i know it is going to be very rough on the family no matter where she is.

Can the same level of care and comfort be given at home?

Mez

[leslie :-D]

i don't see why she couldn't be managed at home.

let the hospice nurses do their thing, and definitely report any distressing symptoms you observe.

for instance, is she struggling for air, does she grimace/moan/whimper?

it's wonderful her family is involved to this extent.

praying for a peaceful time for all involved.

leslie

[marachne]

Update on my lovely lady....

She now has blisters on her legs, Silver Chain is calling in Clinical nurse to assess her today. Nurse said time is going to be sooner rather than later and will be talking to the family about having her admitted to hospice. I know this lady wants to pass away at home.

Her family are willing to stay around the clock to help and just be with her.

In your opinion, what would be the best advise to give - i know it is going to be very rough on the family no matter where she is.

Can the same level of care and comfort be given at home?

Mez

Mez, While I don't know all the details of the situation (where she lives in Oz, other symptoms she might have), my impression is that hospice care in Australia is very good. With hospice care, as long as her symptoms don't get out of hand, and with the large and attentive support network that she has, she should be able to stay home until her death.

That said, sometimes things turn so that the best way to achieve comfort is in an in-pt setting. Example: A friend, who has a background as a long-time ICU nurse, university professor and oncology researcher was taking care of her sister as she was dying at home. Her sister's pain became so intractable that even with the continuous, skilled care and hospice supervision, she had to go into the hospital for her last days. Not what anyone wanted, but what was the best thing for her at that point. Doesn't happen all the time, but I think it's important to be able to weigh a person's wishes against what can/needs to be done in a specific situation.

I wish you all the best of luck with these changes. As I said before, you clearly have a very giving heart, so be sure you take care of yourself too as you grieve her changes and ultimate loss. :heartbeat

[Monica Zilko]

She is always struggling to breath now - very very weak, even to talk at times is too much for her. She is vomiting alot. What could the blisters be, the nurse did not say much about them, just dressed them and called for the clinical nurse to come today. Could they be from lack of circulation in her lower legs and feet?

How long does death take when you are so sick?

Mez

[leslie :-D]

if her legs are edematous, i'm sure it's related to the swelling.

once the fluid overload resolves, the blisters will too.

not sure how realistic this would be, but the blisters 'sound' like a relatively benign event.

it also sounds like she needs more aggressive mgmt of her breathlessness and vomiting.

if the hospice nurses cannot contain it in her home, then an inpatient facility would be appropriate, and much more comfortable for the pt.

keep us updated, mez?

leslie

[Monica Zilko]

Hello all

My lovely lady is back in hospital. She had a fall and was unconcsious. After tests we were told she has septicemia caused by a bladder infection. She is being given antibiotics and they have helped. The doctor is saying she needs to be transferred to a nursing home because she cannot receive the level of care she needs at home any longer. She is very weak, breathing is the worst i have ever seen, i know she is dying (has been for months) but still no one says very much. Her family are devasted. This lady has suffered enough, any thoughts on her outcome.

Monica

[NaomieRN]

Drowning because of too much fluids back up

[Monica Zilko]

Is there anything we can do - how long does someone in this condition normally suffer before they pass away?

[leslie :-D]

Hello all

My lovely lady is back in hospital. She had a fall and was unconcsious. After tests we were told she has septicemia caused by a bladder infection. She is being given antibiotics and they have helped. The doctor is saying she needs to be transferred to a nursing home because she cannot receive the level of care she needs at home any longer. She is very weak, breathing is the worst i have ever seen, i know she is dying (has been for months) but still no one says very much. Her family are devasted. This lady has suffered enough, any thoughts on her outcome.

Monica

no one can say if she's dying or not.

if you say the abx are helping, there's a chance she'll bounce back to baseline.

i've seen many recover from urosepsis.

leslie

[delliott]

I have a 76 year old woman. End stage CHF. Eating has decreased over the past three weeks to less than 300 calories per day. She is on 120 ml laysix per day, stopped all hear meds last week. Pressure 110/70. Sleeps 20 plus hours per day. Question? she has not had a BM in 15 days. She is comfortable, no signs of constipation, taking stool softeners daily. How can she go so long without a bowel movement. Private emailwelcome at [email protected]