Patient dilema

Nurses General Nursing

Published

I have a pt that has not been eating. The family has power of attorney for my patient's care. This patient is only orientated to self. The family decided to put a peg tube on her but she refused. Since she was confuse at that time eg. calling mom out, crying, yelling. They drug her up so they can put the peg tube. I have been taking care of this patient for a week now and she has expressed her desire not continue feeding tube pretty much everyday and to multiple nurses. The doctor brushes my concerns because to her she is just a confuse pt that does not know what she is talking about. I did talk to my charge nurse she said "she has no say with the feedings because she is confuse". To make things worse, she has history of addiction, chronic back pain, diabetic neuropathy, osteomylitis, depression and the list goes on... the doctor took her pain medication away because according to the MD she is just another addict.

At this point do you guys think the pt has the right not to have her feedings?

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Specializes in ICU.

If you can truly say you think she was objecting consider an ethics committee referral and maybe speaking with case mgmt. maybe even as far as a hospice referral.

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Specializes in ER, progressive care.

Just wondering...is this patient a DNR?

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Specializes in retired LTC.
If you can truly say you think she was objecting consider an ethics committee referral and maybe speaking with case mgmt. maybe even as far as a hospice referral.
Social worker consult if LTC (like this sounds). Also a family care conference is in order like ASAP. Don't be surprised if pt tries to pull out the Tube and you're back to step 1 again, so all parties need to be on the same page. Chemical restraint is not a way to do things.

Psych mgt may be in order as it sounds like increased depressions is present, and esp better PAIN mgt.

If she feels better (depression and/or pain), she may be more open to the Tube feeding.

Also, were there any advanced directives to help decision making?

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Specializes in Critical Care, Education.

Agree with PP - this situation needs to be referred for an ethics case consultation ASAP. Waaaaay too complex and involves too many non-patient factors that a nurse cannot address.

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Specializes in Medsurg/ICU, Mental Health, Home Health.
the doctor took her pain medication away because according to the MD she is just another addict.

I'm sorry, what?

Is that really a problem right now? Even if she is an addict, just cutting off her pain meds is cruel. And it doesn't sound like this woman is in the position to go down to the corner and score some dope, or even have a dealer come in and see her.

If she is requiring tube feeds, she is obviously very ill and why does it matter if she is an addict?

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Specializes in Med/Surg,Cardiac.

I think it's very important for this reason for everyone to, at a reasonable age, draw up some type of advanced directives. I find situations like this immensely sad.

Advocate for her. Get more people higher up involved. And taking away her pain medicine is terrible, especially if the reason is addiction. Ugh..

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

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Specializes in Emergency & Trauma/Adult ICU.

If the patient is oriented to self only, she cannot direct her care at this time. I agree with the posters above - this situation would have me consulting ethics.

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Regardless of what the physician thinks (they aren't always right, you know), even a confused patient can know enough to refuse care, especially if she is consistent about it. You don't have to know where you are or who's president to know you want to refuse a feeding tube. This is a horrible situation and I hope you have a good ethics committee in your facility or corporate structure, because this is completely unethical if it is as you describe.

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Specializes in Hospital Education Coordinator.

check your policies. You may need to use the chain of command to be taken seriously

Withholding pain medication is simply cruel. Is it necessary to PUNISH a disabled person???

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No, family wants CPR

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No, family wants CPR

This breaks my heart. I agree with Previous posters. Contact social work, your DON, obudsman, whoever will listen.

Continue to be an advocate.

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