Hospice RNs- How would you interpret this?

[DLS_PMHNP, MSN, RN, NP]

Hi,

I'm new to hospice nursing. On my last shift, I had an 80 y/o pt (end-stage CHF) call me into her room, convinced she was pregnant. I did my best to alleviate her fears and re-orient her to reality, but this went on, sadly, for most of the evening.

She was genuinely concerned/agitated because she was very much afraid she was pregnant.

For those of you with hospice experience, how would you interpret this? She also made reference to the fact she hadn't had sex in over 35 years, because that is when her husband died. So, she "didn't know how she could possibly be pregnant" but she was convinced she was. It traumatized her.

She was not in the process of 'actively' dying yet.

Any input?

Thanks!!

Diane, RN

[leslie :-D]

haldol and a 1:1 (after pt calms down a bit), explaining changes going on with her body/mind.

would also further assess what she is feeling in her abdomen.

leslie

[angieRN]

It could just be fluid collecting there from her CHF. Depending on the level of dementia...we've told patients with edema in areas that question why, that the fluid is being kept there like "money at a bank" so that the heart doesn't have to "look after it". It makes the heart's work easier.

[DLS_PMHNP, MSN, RN, NP]

Thank you very much for your replies.

It's nice to hear other nurse's viewpoint on this.

Best,

Diane

[Whispera, MSN, RN]

CHF-->lack of O2 to brain-->confusion. Plus, so many things are going on in a dying person's body that can cause delusions...it's hard to say exactly what is going on in this particular person. I agree with the haldol and a 1:1 plan mentioned by a previous poster.

Incidentally, a UTI is something that causes sudden onset delirium in elders very easily...

[marachne]

CHF-->lack of O2 to brain-->confusion. Plus, so many things are going on in a dying person's body that can cause delusions...it's hard to say exactly what is going on in this particular person. I agree with the haldol and a 1:1 plan mentioned by a previous poster.

Incidentally, a UTI is something that causes sudden onset delirium in elders very easily...

Whispera, thanks for your response -- I had a really strong reaction when angieRN used the word "dementia" no where in the description by the OP did she indicate that kind of cognitive change. Dementia is a very specific disease, where as cognitive changes are common with many terminal conditions (as well as acute onset issues like UTIs). One of the things I have become more and more aware of is the insidious issue of ongoing hypoxia in HF and COPD -- and how little it is acknowledged by professionals or explained to patients and their families.

[tewdles, RN]

definitely agree with the suggestion for haldol. am sure you looked for any signs of something going on in her belly...and cognitive changes surely can give folks some strange ideas.

[Momto3CT]

An important thing to remember with elderly patients, end of life or not, is that any sudden, acute change in mentation...agitation..etc.. could be related to an onset of delirium. Delirium is misdiagnosed so many times. The key, as mentioned above, is to see if there is something else going on..i.e...UTI. We have had so many patients with terminal illnesses come into to the hospital because family thought they were starting to die when they really had an underlying problem that caused the change in mentation. Someone could be in a hypodelirium...somulent..or hyperdelirium...agitated, confused, hallucinating. Look for any infection if the change is acute and notify the MD. I do home care also and we had someone admitted to hospice when they weren't really beginning to die from their terminal disease, but had an infection and went into a delirium. After antibiotics for a UTI, pt went back to baseline. This is especially true in end stage dementia when they stop eating and become somulent...maybe due to something else. It can get tricky!!

[DLS_PMHNP, MSN, RN, NP]

Whispera, thanks for your response -- I had a really strong reaction when angieRN used the word "dementia" no where in the description by the OP did she indicate that kind of cognitive change. Dementia is a very specific disease, where as cognitive changes are common with many terminal conditions (as well as acute onset issues like UTIs). One of the things I have become more and more aware of is the insidious issue of ongoing hypoxia in HF and COPD -- and how little it is acknowledged by professionals or explained to patients and their families.

Thank you very much... your post is very informative

[MarciCRN]

In my experience, people in their last day/hours can say things and mean another. Maybe she had strong feelings about pregnancy either pos or neg...and in her delerium she said pregnant and meant something else. Just a thought.