Hospice patient receiving TPN ?

txspadequeenRN, BSN, RN · Dec 12, 2005

i have never had a hospice patient receive TPN but cont with G-tube feedings yes... What I dont understand is ...why is the patient on hospice and a full code.. Happens everyday and just blows my mind.

I'm confused. Why would a dying person be receiving a great big bag of TPN every night? Isn't that against the hospice philosophy? Thanks:)

Blackcat99 · Dec 13, 2005

This lady is receiving a lot of TPN and is a no-code. At my hospice, all patients have to be no-codes. Yes we have had patients receiving tube feedings too.

aimeee, BSN, RN · Dec 13, 2005

If she doesn't have a functional intestinal tract, then the TPN is sustaining her. You don't say whether she is able to interact with her family. If she is alert, then the TPN might be viewed as allowing her to complete the work she must do in saying her goodbyes and resolving any issues with her loved ones before she dies. If she is comatose, perhaps it is allowing her family to work through some grieving issues without feeling like they caused her death by depriving her of nutrition.

chris_at_lucas_RN, RN · Dec 13, 2005

I didn't think hospice patients were codable, but I sure thought we could feed them.

TPN is total parenteral nutrition, isn't it? Keeps the body fed so that the patient doesn't experience hunger? (I'm thinking hunger sensation occurs when cells have insufficient glucose and send out biochemical messages to that effect.)

Makes sense to me--nourishment and hydration are first line comfort measures...... Plus comforting to the family. Bad enough the family member is dying but not feeding them...... :stone

GooeyRN, ADN, BSN, CNA, LPN, RN · Dec 13, 2005

Codable hospice patients? Wow. Isn't hospice for comfort measures when death is soon to be knocking? Why would you code them?

babynurselsa, RN · Dec 13, 2005

What it ultimately boils down to is that the patient and/or the family has the right to make the choices about their code status/tube feedings/TPN, etc.

Sometimes the patients choices do not fit the basics of the hospice philosphy. It is not our job as a hospice to TELL them how their passing must be. It is our job to give them a peaceful and comfortable a death as possible.

Would I as a hospice nurse recommend TPN, probably not. They may have feeding issues that are actually unrelated to their hospice dx. OR was the TPN initiated PRIOR to admitting to hospice service. Many families initially are not ready to start withdrawing things that are already in place.

There are too many variables to adequetly answer you question.

CANRN, MSN, RN · Dec 14, 2005

I'm confused. Why would a dying person be receiving a great big bag of TPN every night? Isn't that against the hospice philosophy? Thanks:)

We have had patients with feeding tubes, but after the natural process of the body slowing down and digestion slows, we have stopped them. Force feeding a patient who can not handle the feedings causes a great deal of discomfort. We have taken patients who have been on TPN in the hospital but the infusions were stopped when they came on Hospice.

We have several full code patients. It's their right and we can not force them to be DNR's. We just explain the ugly details of being resucitated. Most people think, "Well, if it's not the ________(fill in terminal disease) that kills me, I want to be resucitated." Most people think that if it's not the cancer, or whatever that kills them, they will be all right. Not the best logic, but it's still their call. So far, once they have passed, and we get to their residence, the family members tell us not to do anything.

Tweety, BSN, RN · Dec 14, 2005

Many hospice patients, especially those early on in their diagnosis are still recieving palliative care, not curative mind you, but not end of life last breath care either. This might include TPN. I've had hospice patients come in for dehydration, UTI's, dyspnea, all kinds of palliative care when they aren't necessarily in the active process of dying, but still have a terminal disease/condition.

RnRatchet · Dec 14, 2005

We don't require our pt's to be a "No Code" to be in our program. Often times though, after education of the patient and family and showing them how the body is slowing down they change their minds and make them a No Code.

I'm an admission RN for my hospice and tonight when I talked to a family about Code Status, the pt said, "Well, I guess they can try for a little bit." Then he admited he wasn't quite sure what the differences were in the code levels. I explained all his choices and they are going to talk about it as a family and then decide and have one our SW's come and help them fill out living will papers.It's nice when families are open with each other and can communicate their wishes openly.

Blackcat99 · Dec 14, 2005

Thanks all for your messages.:kiss Yes it does make good sense to let the patient/ family decide for himself/herself what they want to do.

Mazzi · Dec 15, 2005

Picked up a hospice pt 5 days ago that stopped TPN that day. Guess what?? He ate po (few bites) of potatoes and green beans yesterday and had two eggs and toast for breakfast today and is feeling better. Dx: ES liver disease (from TPN....hmmmmmm).