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How does hospice care determine there is no coming back

Hospice   (629 Views 8 Comments)
by usethehaldol usethehaldol (New) New Nurse

340 Profile Views; 17 Posts

I am not the power of attorney here.

Hey guys. My grandmother is in the process of passing and I wanted to ask some questions on hospice care. I'm a new ICU nurse and a paramedic and I've never done hospice care.

My Grandmother is 94ish and the major hx is middle stage dementia, CHF, and afib. I don't remember her ejection fraction but it was something low. Up until 4 days ago she could walk back and forth to the restroom (10ft?) but would have mild dyspnea. This was her baseline. 

So 2 days ago she fell twice and hit her head. No LOC, no external bleeding noted. Shes not on blood thinners. Hospice care came and said shes on the way out. Yesterday she had the coffee ground emesis. Now she'll try to open her eyes to voice and will occasionally scratch herself.  Hot to the touch.

I dunno guys, half of me wants to start some normal saline and call 911 but as I type I see that doesn't make sense. I guess I look at her and check her pulse it just looks like she has a fever and that I should be doing something besides giving a tylenol suppository.

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56 Posts; 2,445 Profile Views

sounds like she's sick and thats why she fell. but, if i was 94 with dementia , and if my PREDEMENTIA self could choose........then tylenol sounds great.

my mind would be the one thing i wouldnt wanna lose. and at 94 she's had a long life

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553 Posts; 10,645 Profile Views

Hi. I'm not sure why the hospice person (RN? MD? LVN?) said your grandmother is on her way out. Being ambulatory one minute and then not the next minute does not constitute someone being "on their way out." I have seen some amazing and interesting things with patients on hospice. Having said that, I imagine that the hospice person thinks that your grandmother has now entered a different phase, which may or may not last for a while.

The details you provide are a little sparse. Is she non-verbal now vs before her accident? Is she more lethargic? Is she still eating/drinking? If she's having coffee-ground emesis, is her BP tanking and her HR becoming elevated? Is she having dyspnea at rest now? Any urine output? 

I am not here to tell you what to do but I feel relieved you are able to self-identify that starting an IV on her and calling 911 would "not make sense," esp since she's on hospice and is 94ish with dementia and possibly end-stage CHF. The goal of hospice is to make her comfortable and as safe as possible. Thanks for listening.

Edited by db2xs
clarification

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Nurse.Kelsey has 0 years experience as a RN and specializes in Pediatric Home Health (LPN).

135 Posts; 982 Profile Views

@usethehaldol Sorry about your grandmother... My own grandmother passed a few weeks ago and was on hospice as well. They determined she was on the way out because she stopped eating or drinking, was mainly sleeping and barely responsive to stimuli. After a good 2-3 days of that they told me she was iminant. Before that she was bedbound, full asssit, and would talk.

 

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17 Posts; 340 Profile Views

Her skin is tenting now and I tried to give her a teaspoon of water when she was briefly alert, against my own judgement, and even that was a struggle. So no more water. It is distressing that I cant give her anything to drink. I use moisturized to keep her mouth and lips wet.  Last thing I want is to see her choking. Hospice Nurse is an RN, I have no question shes looking out for all of us. She really is amazing

Shes super lethargic, Her urine output is still good. She just sleeps. When she looks like shes in pain I give PO morphine around the cheek, its all we have.

94 years is a good run. Thank you for all of your input. Hospice nurses are a different breed.

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553 Posts; 10,645 Profile Views

2 hours ago, usethehaldol said:

Hospice nurses are a different breed.

I say that about ICU and ED nurses! 🙂 

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Kaisu has 2 years experience.

144 Posts; 1,884 Profile Views

Bless you for being there for your grandmother.  I know how truly difficult that can be and you are making wonderful decisions for her.  Being with her, talking to her and caring for her will make processing the grief after she moves on so much better.  You will have moments with her that you will treasure forever.  

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Silverdragon102 has 31 years experience as a BSN and specializes in Medical and general practice now LTC.

7 Followers; 1 Article; 38,919 Posts; 143,286 Profile Views

I am sorry you are going through this however as per the Terms of Service of the site we cannot offer medical advice. You probably should be talking to her doctor. Closing this thread

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