Family just wants Grandma to die

linearthinker, DNP, RN · Mar 4, 2011

I understand their thinking. At some point, it is time to stop running from the inevitable. Pneumonia is "the old man's friend," after all. Shrug it off and move on.

roser13, ASN, RN · Mar 4, 2011

This is not a comment on your particular situation since I don't know any more about the patient than the few details you posted, but pneumonia used to be known as "the old man's best friend." In other words, before antibiotics were used widely used (or mis-used as the case may be), pneumonia would hasten an elderly patient's death and help him/her avoid lingering on and on in pain.

Again, this doesn't sound like your LOL. Your post just reminded me of this little piece of nursing lore. Out of curiosity, apart from the lack of antibiotics, is the family otherwise supportive of Grandma?

ktwlpn, LPN · Mar 4, 2011

One of the hardest things about LTC is this type of end of life situation. Usually the family wants it all and we know it's futile and is just prolonging suffering. Help this resident along her path as well as you can no matter what her destination may be-that's all you can do. I have to say that I admire them-that decision is NOT easy. Also suspecting that some staff don't agree makes it harder and that's not fair to them. .

anonymurse · Mar 4, 2011

Has she formally been found incompetent to make her own decisions?

bagladyrn, RN · Mar 4, 2011

Having watched my formerly intelligent and well loved aunt start on the downward spiral of Alzheimers, knowing where that inevitably ends, I am grateful for the pneumonia that took her while she was still (at times) able to realize she was home with her family around her.

Altra, BSN, RN · Mar 4, 2011

My own elderly family member's advanced directive explicitly states that she does not want antibiotics.

Consider that antibiotic treatment is not without ramifications -- for an 80+ year old, it can be a short trip from chronic renal insufficiency to blowing out the kidneys after a round or two of Vanco or Zosyn.

Platypus · Mar 4, 2011

Roser, working night shift I never see the families of residents for the most part, unless they are very near death. Other shift nurses have told me that the family does come in, but do not stay long.

Anon, this lady has Alzheimers and cannot make her own decisions. One of the nurses told me that having pneumonia is like feeling a very heavy weight laying on your chest, that cannot be comfortable at all. A long slow suffocation...

Thank God for O2, Roxanol and Ativan

linearthinker, DNP, RN · Mar 4, 2011

If I get Alzheimers, don't wait for pneumonia, put a pillow over my face. In short, I agree with the family and I wouldn't treat it either.

tiroka03, LPN · Mar 4, 2011

I am reminded when I cared for my mom at my home. I was a single mom, worked full time and had two children with disabilities. During those years, I worked endlessly day and night. It was a very good and also a very difficult time. Sometimes I loved my mom, and othertimes I resented her. It was more the exhustion, then real feelings, but I didn't know it then. So, I started to think I was really selfish, and was upset over my more negative feelings. One of her problems was alzehiemers. When she started waking in the middle of the night, and began wandering, I finally made the deceison to place her in a long term facility. By this time, I was so worn out, I didn't have it in me to do frequent visits. I had to regroup and get my strength back physically and emotionally. About the time I was beginning to feel stronger emotionally, and had gotten some sleep under my belt, my mom started to decline. (again). You might know that sometimes families go through a roller coaster ride with illness, near death, and back to health, only to repeat the cycle over and over again. You drop everything, take time off work, You begin grieving, praying, begging, and then she's fine. Two months later it all starts over again. It takes a toll on you.

By the time my mom, (and it was her deceison) decieded to forego an operation that would bring her back to the repeating cycle, I was exhusted. Then the family who all stayed away for years, now wanted their wishs to be known and met. Everyone, everywhere came out of the woodwork. If dealing with the doctors and the staff at the nursing home weren't enough, I had to deal with many people who had no idea the things they though would help, really wouldn't. This was very hard, and some members of my familty wanted to start taking her things now, before she passed. Suddenly 90% of her clothes went missing, suddenly her bedspread and bathroom and slippers were gone. Not by a roommate or lost in the laundry, but by family members. I had bought those things with my own money, and now had to go shopping and replace them. It was just all so tiring. I stuck with my mom's wishes and she died with me beside her. None of them could be bothered to sit with her, and I called them all.

The day before she died, she rallied, she had been comatose for a couple of days. It was her birthday. She sang, danced, ate a Subway sandwich, blew bubbles and make a tape recording saying goodby to everyone individually. Then she said she was tired and we laid her down and kissed her good night. She died the next afternoon.

I was tired, to the point of not feeling anything emotionally, I had given all I had for years. We don't always see the background of what has happened before they get to us. They may be just all used emotionally.

leslie :-D · Mar 4, 2011

i guess i'm the only one who is disturbed by this.

even when on hospice, i always got treatment for infections, whether uti or uri...

as long as it wasn't r/t the admitting dx.

i'm not going to get long-winded about this, but i think it stinks to high heaven.

leslie

ktwlpn, LPN · Mar 5, 2011

i guess i'm the only one who is disturbed by this.
even when on hospice, i always got treatment for infections, whether uti or uri...
as long as it wasn't r/t the admitting dx.
i'm not going to get long-winded about this, but i think it stinks to high heaven.
leslie

After my mother was initially diagnosed with cancer one of the first times she was hospitilized with sepsis her oncologist told her that there would soon come a time that she might want to think about "letting an infection run it's course" This was before she even started treatment. I was really not pleased with the way that message was delivered. She lived 18 months.

Back to the OP- this resident has Alheimer's and pneumonia and we are all familiar with that ugly downward spiral-course after course of antibiotics with all of the resulting side effects. Most of our resident's living wills specify "no antibiotics" Unfortunantly the culture in my LTC is not pro-hospice and they are almost always called in at the very end-well past the point the resident in the post is experiencing. I imagine that you are used to recertifying long time pts frequently and caring for people that have a good quality of life for a length of time. Alzheimer's just gets uglier by the day-I HATE that freaking disease.

They all have good moments and bad-the good can be great but the bad are horrible.