Disturbed...

Straydandelion · Oct 23, 2008

I hope he has hospice looking out for him also. As far as assigning a student nurse, I would think that would be up to the patient. If the family can't be there at certain times, anyone with him IMO would be better then alone. I always think the saddest thing is for a patient to die alone and have sat with some when they seem to have no family available. As far as the NPO, I am just guessing he has aspiration difficulties and all have refused NG/PEG/G tubes.

(I haven't worked in a geriatric setting much however, in fact just briefly)

CoffeeRTC, BSN, RN · Oct 23, 2008

Often times, pts that are in the dying process, do not recognize hunger. Depending on their medical status, resident wishes, family wishes...we feed prn. Never would we tell someone "no...you can't drink or eat" A dying persons wish is always considered. My grandfather just wanted a beer...a beer is what he got. Actually, just being "allowed" to have it and taking a teeny, tiny sip was enough for him.

On the other hand..the hunger/ thirst drive is often lost. The body is using its energy for other systems and mostly shutting down. Mouth care is very important and can be considered comfort care but other times..it could be very uncomfortable.

Does this person have pain meds or an antianxiety med ordered? We like to try and give those meds before care like a bath,etc.

As far as assigning a nursing student ADLs etc...depends. Some families would say no..please don't and that is thier wish. I know when my dad was in the hospital and dying...we had a few nursing students that were assigned. Poor dears...he already had a room full of nurses (sis, me, mom, SIL) they couldn't get thier hands on him. We did try to include them in his care so that they can learn. You have to learn sometimes, huh?

kellyc034 · Oct 23, 2008

I think it is common to assign a student to a hospice patient. I had one my first semester and I have them all of the time at work as a PCT.

From what I have seen (and you seasoned RN's correct me if I'm wrong) is that generally if a person is "actively" dying the hunger sensation is alot of times decreased, consciousness is altered affecting ability to eat, and swallowing ability may be lost. NPO is very common on hospice to pt's that are in the last few days of life. You should swab to preserve oral care and remove secretions to increase comfort as well as "wet the whistle." If the pt is conscious, verbal, A&O you can always offer nutrition unless it is contraindicated for some other reason.

As nursing students, we need to learn about death and the dying process, care of the dying person, palliative measures, etc. No other way to do it than to just do it. Giving a person a bed bath while dying is a great thing, the pt's have a right to be clean and die with dignity, even though they may not be able to communicate that verbally. It really is a great gesture, not a cruelty. Even as students, personally, you know how good it feels to be clean. Unless the pt is in extreme pain or agitated, I'm betting that if they could tell us, they would say they feel better after a bath too.

Taking care of hospice pt's is not for everyone, and I know as a new nurse or new nursing student it is sometimes difficult, sad, or overwhelming. I've even heard other students say it's "creepy" (I don't have that opinion). It's new to you, and sometimes scary, and that is OK. :wink2:

I'm sorry you had a bad experience with it!

Kelly

DroogieRN · Oct 23, 2008

Thanks to everyone who replied. I really appreciate your knowledge and experience. Maybe to clarify: his family says he can have nothing. They aren't in often and have removed all his pictures, etc., from his room. He is non-verbal, but the way he went after that toothette seemed to indicate he is very thirsty. His family wants him to have nothing NPO and no IV fluids. Hospice is not involved.

edited to add more details.

SuesquatchRN, BSN, RN · Oct 23, 2008

Thanks to everyone who replied. I really appreciate your knowledge and experience. Maybe to clarify: his family says he can have nothing. They aren't in often and have removed all his pictures, etc., from his room. He is non-verbal, but the way he went after that toothette seemed to indicate he is very thirsty. His family wants him to have nothing NPO and no IV fluids. Hospice is not involved.
edited to add more details.

What does the assigned nurse say about fluids?

DroogieRN · Oct 23, 2008

That he's not to have any.

hikernurse · Oct 23, 2008

Sometimes nursing students can spend more time with patients than nurses can. That could be a kindness with a dying patient. As a family member I wouldn't want a student nurse "practicing" anything potentially uncomfortable on my loved one, but wow, if there were time for a student to sit and hold a hand then I'd be all for it.

racing-mom4, BSN, RN · Oct 23, 2008

Personally I think it is good for students to see 1st hand the dying process, if family is OK with it, they should be happy they get a student who can provide so much 1:1 care.

Pt may be NPO for reasons listed in earlier posts, do though keep up on good mouth care be it the sponges or even damp wash cloths--dont forget lip moistner as well. I also keep the eyes moist with damp wash cloths.

I am hoping this pt has morphine ordered for pain and the nurse assisgned is keeping up on thier sched dosing. If not as a student you can remind her "it is time for Mr Xs morphine, do you want my instructor to get it for you. "

Remember hearing is the last thing to go so before you do anything for the patient tell them "Mr X here is a warm wash cloth for your face-Mr X I am going to turn you towards the window~it is a bright sunny day"

Make sure he has clean wrinkle free sheets and his gown is clean and dry. Use plenty of loition on his back and upper/lower extremeties. I also put the lotion bottle in the tub of warm bath water to some what take the chill off.

nerdtonurse?, BSN, RN · Oct 23, 2008

I had a similar experience as a student nurse, how dare they not give a pt a drink, etc. Since, then, I've learned more about the dying process. Previous responses have been right on, but just my 2 cents...

---Families will not do what you would do; I've had to call pt families in the middle of the night to tell them that their husband/wife has gone unresponsive, is now on 100% oxygen, they are not doing well, and that if there's any family to be summoned to the bedside, now's the time to call them, only to have the spouse say, "well, what are you bothering me for, don't you know it's 4 in the morning?" Ummm, I thought you might want to say goodbye, but maybe not....I've seen families start pulling away from a dying pt, especially if the person has been very ill for a long time. Also, keep in mind, child molesters, wife beaters, and unfaithful spouses still die. I've had an adult child tell me that she would not authorize lifesaving surgery for her father, because he repeatedly raped her as a child -- and all the other children said the same thing.

---Swallowing. I've had people clamp down on the sponge as well, but if that person can't protect their airway, the last thing you want that person to do is choke to death -- if they don't eat/drink, they go to sleep, go into a coma, and pass, if they choke to death, they die in terror. I've seen families refuse to put in a PEG tube on someone who's dying -- I've also seen them put a PEG in people in their 80's, 90's and even 100's, and many times, they do not live 30 days after the placement of the PEG. They get an infection, they get pneumonia, they can't tolerate the feedings because they've been anorexic for weeks, and dumping Jevity into a shutdown GI tract won't make it work. It may be the "NPO" order is a family refusing a PEG. They should have pain meds available, and I'd also ask for some kind of Ativan to keep the person calm and tranquil.

It never gets easy, dealing with death. But often, unfortunately, we have the medical means to prolong death, rather than prolonging life...

Dolce, RN · Oct 24, 2008

I do not at all think it is cruel to bathe a dying patient. Bathing a patient can be very comforting. Nursing students are wonderful for dying patients because they have the time that those patients need.

There are many ways of moisturizing the mouth and providing oral care that can be a comfort to a NPO patient. It is possible that the family has not wanted him to fluids because he has been aspirating. I don't know if you have ever watched a family member die before, but it is not easy. I would hope that this family is keeping the patient NPO for good reasons and not out of maliciousness.

DroogieRN · Oct 24, 2008

I don't know if you have ever watched a family member die before, but it is not easy. I would hope that this family is keeping the patient NPO for good reasons and not out of maliciousness.

I have, and I know. And thank you and all of you who've provided me with such thoughtful and knowledgeable responses. I am feeling a lot better about it now, after a night's sleep and after reading these posts.