stopping dialysis

[gomernurse]

A 68 y.o. female in our LTC has made an informed decision to discontinue her 3X week dialysis treatments. We, of course, are supporting her and her difficult decision. I am assuming she will begin to have some confusion and edema. She is already oxygen dependent. I need to know what other physical problems she might encounter so I can get a jump on helping her through this.

(Have already place scopolamine patches).

Thanks for your input.

[psychonurse]

I admire your patient in many ways. To have the courage to stop all the suffering and hopefully slip into a coma and go to her maker peacefully. We had a patient not to long ago that went into status epilipticus(it is late and I am in the middle of some overtime so my spelling might not be the best) But he had other problems along with his kidney problems. But confusion is one of the biggest problems that I have seen with end stage renal failure.

[sjoe]

Good for her. Too few patients know when to say "when" and fewer still have the courage to actually stand up for themselves and their personal interests when this time has come.

I assume this patient has already established her advance directives, including a DPOAHC, living will, last will and testament, etc., so that no relatives come out of the woodwork at the last minute to inflict their personal wishes (and/or greed) on the situation.

[BrandieRNq]

I work with these types of patients...usually 1 every couple of months. Our facility is also a place where life support is terminated. (Start MSO4 and Ativan gtts and stop ventilator support) It is an amazing process patients and families go thru. Sometimes the patient is pretty much out of it or confused and their family feels this is not how they would want to live so they make the decision. However, the patient is sometimes very aware of their choices and is making a clear decision, fully knowing what the consequence is. They make plans to say goodbye...(waiting for all family from far away to get there) I feel so honored to be a part of this process...I can't even say in words here how it effects you.

[Disablednurse]

My husband is a diabetic with renal problems. He has told me and is writing a living will with his wishes to never go on dialysis. This past July, I was almost put in a position to where I was going to have to make the decision for him as he almost died r/t toxic levels of blood pressure meds in his system. I know that I would have chosen to leave off the dialysis because of what he has asked for. He said that he did not want to be tied to a machine for the rest of his life. I support his decision and our doctor supports his decision. I do realize that it will be hard when the time comes, but it is his decision.

[PCav]

God bless your patient for her brave decision and you for supporting her! I was a dialysis nurse myself once, and also my grandparents both made the same decision and it wasn't easy on anyone but ultimately it was what they wanted. Luckily both did not suffer the SOB and extreme edema, mostly the confusion and some lack of bowel control. We gave them all the potassium-rich foods they wanted and were told that would hasten the process a bit -- pain-free and much more comfortable and I can tell you they both passed very peacefully in a matter of days.

Everyone is different but with great nurses like you around she will spend her last days filled with dignity.

[TX Guy]

Wow, once again I am amazed by you guy's incredible strength in the face of extreme circumstances. I only hope that I will have the strength to handle such things when I am a nurse.

I believe if forced with the choice, I would follow Ernest Hemingway's lead before I would live connected to a machine.

P

[-jt]

Youll may be suffering more watching it than she will be feeling it. It doesnt look nice, but renal failure is mother natures humane death. The toxins that build up cause a euphoric effect and natural anesthetic. She will not be in pain. Her appetite for food & fluid will diminsh, so dont force her. A wet cloth to her lips or a couple of sips may be all she wants & needs. But she will look and sound uncomfortable to you as fluid builds. Position her well in the bed and give her O2. For comfort care, we have given small doses of MSO4 occassionally if the pt was still awake and having difficulty breathing, but usually by that time, they are not conscious. Towards the end, she may have seizures from the lyte imbalance, but she will not feel or know it. Just remember that it looks worse to you than what she is feeling. It may not look it to those watching but renal failure is a peaceful passing.