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How long will he last?

Posted

I am an ER nurse with 2 years of critical care. I am very familiar with the dying process, but not once it leaves the hospital.

A family member in his 70's with a 40 year history of Parkinson's had a massive stroke 3-4 days ago. His vitals have been rock solid stable since. He has been on palliative care only- nothing but ms at this point- since the stroke, and is moving to home hospice tomorrow.

No nutrition, hydration or abx.

What is the likely timeframe? I realize that there is no way to know, but..

I have family overseas, and am trying to help them decide what to do.

Knowing what I know what guidance might you give?

I appreciate any input.

herrn

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

In the absence of any hydration it would be reasonable to anticipate that he will not survive more than a week. However, having said that I must caution that each situation is VERY different. I just cared for an obese woman with a trach and PEG tube who survived for 3 weeks with no nutrition or hydration. Was it her trach humidification, the water stored in her fat cells, or was a family member covertly providing water per PEG?

sclpn

Has 4 years experience.

when faced with the "how much longer" question re: calling in family I always tell the family to go ahead a call because sooner is usually better. We only can go by the clinical signs of impending death but we are not God.....who has the final say

Hope this helps

Lynn

I have had many patients die, and am familiar with the process. I realize there is no way to know, I am mainly looking at likely timeframes.

Tomorrow he gets transported home, and I will stick around till he is set up. From what I understand, he will be getting two RN visits a week. This does not seem like enough. I am curious about who will be taught what, and how lay people will manage this death.

No more than 10 days.

Medicare is getting stingier with their visits. Two a week is pretty good. Will he have a HHA? These kind souls are the heart of home health nursing. They have been my eyes and ears for so long. It is their job to bathe the pt and do basic cares for 45 minutes at least twice a week.

Is he going to hospice? This is such a good thing. It increases the services available to some patients through separate Medicare and insurance hospice benefits. These are some good first questions to ask.

Let us know how it goes.

centex

Edited by ellakate
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I am posting at the bedside. Transport to home hospice at 1700.

The hospice RN did an intake assesment while I was here, and reviewed the plan. He has had Parkinsons for 40 years, and has had 24/7 aides for a while. the house has a hospital bed, and my aunt is no stranger to medical issues.

The plan sounds comprehensive and effective. the nurse was competent, and gave the palliative care doc, who wrote the initial orders, good guidance. the doc was thinking mostly suppositories, but this agency uses mostly gtts, which seems like a good idea to me. How you can get through medical school ant not fully grasp the difference between SL and PO is a bit of a mystery, but the nurse got the orders she wanted.

Essentially, O2, but no hydration, nutrition, or medication, other than:

Ms 5 mg q1 prn.

ativan 0.5 Q1 (seems low)prn

atropine prn

hadol prn- seems unlikely to be needed

Compazine-won't be needed

tylenol prn

dulcolax, qd.

I am re-eforcing the message to call the agency, and not to call 911.

All in all, I am confident in the plan.

From what I hear with my naked ear, he will have pneomonia soon.

BTW- about once an hour he has what appear to be a few hiccoughs. Any thoughts on management if they get bad? Thorazine? Are they something other than hicoughs possibly?

BTW- about once an hour he has what appear to be a few hiccoughs. Any thoughts on management if they get bad? Thorazine? Are they something other than hicoughs possibly?

thorazine is used yes, but you have access to the compazine and/or haldol, either/both of which would work as well.

leslie

When my Dad was dying, his hospice mixed ativan, benadry and haldol in a concentrated liquid. If he got antsy, he got a squirt. It was ordered every two hours, but in the last 24 hours, I gave it as often as I needed. Oops! As often as he needed it.

From the spiritual side: Even though Daddy was comatose, our family took holy communion together. We found out after his death that Dad had often gone to the young ministers and offered a friendly greeting, sharing thoughts and prayers. Who knew? He was a reprobate, but he was my reprobate. God love him!

hherrn, from your last post, it seems that things are proceeding nicely. Thank you for taking the time to help your family. With your knowledge, you can help soothe their fears and calm them when things get tough.

Sorry to ramble, but does he have AICD? When Dad died, his fired twice. I am glad that no one was hugging him and that everyone else had left the room. It was kind of gross.:eek:

9 days of no nutrition or fluid. Occasionally morphine to facilitate moves.

I am not there, and won't be till the funeral, but apparently, there haven't been many changes since the stroke.