Fighting For Mom

[ltcnurse4u, CNA, LPN]

We have a repeat resident admitted a few weeks ago after a fall at home that resulted in a broken right hip and dislocated right shoulder. She is a very small 93 year old, she has severe dementia and suffered a stroke last year that has severely affected her speech. She also has severe swallowing problems and is having a hard time tolerating pureed diet and honey thick liquids. She has been in our facility 3 times since last May d/t falling at home. She has been living with her daughter at times and she also has lived with her granddaughter. There is another relative who she also has lived with. There is a sister in another state listed as her POA. When she was admitted this last time, her doctor stated he will NOT signed discharge orders and if the family wants to take her home, then it will be AMA and he will file a VA. It gets even better. She now has cancer and her daughter wants her to get chemo and radiation for it. She came in on Monday with all these vitamins and oils and teas for her mom to start taking. On Tuesday, she aspirated on her dinner and is now being treated for aspiration pneumonia. Last night, she her sats started to drop, her lungs sounded like they were filling up with fluid and she spiked a temp despite being on an antibiotic. I checked her polst form and noted she is a full code. YIKES!! I called her sister to give her an update and asked her if she wanted us to treat her here or send her into the hospital. She said she is flying out this week to see her sister and sign paper work. She feels with the new dx of cancer and her declining status, she thinks its time to change the polst to a DNR. She wanted us to keep her at the nursing home and make her comfortable. I did explain that until the form is changed I have to go by what I have and she understood. I updated the doc on call and he ordered for IM Lasix 40 mg x 1. Update him in an hour. After the Lasix, her sats did improve and her breathing was better. Vitals were stable. She appeared comfortable. I watched her like a hawk the rest of the shift. I spoke with her daughter (she calls regularly) and she was insisting that she be seen in the ER . I advised her what the doc ordered and what her sister had stated. She kept insisting I send her. I checked on her again and she was stable. She was fine when I left. I came back in for a meeting and heard that she had passed away around lunch time and that the daughter was LIVID on the fact that I did not send her in.

I sit here now questioning every step last night but I don't see where I went wrong. I don't feel as though I should have sent her in. I called the POA, I called the Doc. I followed the orders I received.

Would you done something different?

[ShaneTeam]

I am sorry that you went through that. And my prayers go out to the family.

You did what you were supposed to. The POA stated not to send her, and the Dr. gave you an order, which stabilized the resident. You stated the resident became stable. If the daughter wanted to make those decisions, she should have advocated to be the POA.

The family dynamics is what is going on. It happens often at this stage of our residents' lives. Not all family members will agree, and they will blame the staff, instead of arguing with the POA. I know it sucks, but this will not be the last time it happens.The only thing I could suggest would be to ensure all of the calls and responses are in the chart.

[CoffeeRTC, BSN, RN]

It really stinks to be put in this position. You did treat and assess her at the SNF. As long as you charted all of the above and the converstations you had with the family, you should be okay. Was she A &Ox3? If not, the POA would be making the decisions. The POA said to keep her at the SNF.

[kbrn2002, ADN, RN]

I know that this thread is a couple of weeks old but I wanted to chime in and let you know you did exactly the right things. Regardless of the difficult family dynamics you followed the instructions of the POA and the MD which is what you are required to do. I am sorry you got stuck in the middle of a difficult situation and sad that this family will be dealing with their obvious difference in opinions on how things should have been handled long after Mom is gone.