End of life question

[crb613, BSN, RN]

Pt transferred from ICU for comfort measures only. B/P had been maintained w/Levophed...Levophed dced ~ 12 hrs ago. Pt is septic, urine bloody w/sediment output 600 cc 8 hrs. BP 72/42,HR 133-142, resp 33-34, Temp 99.4, sats 98-100% on 2L. Skin is warm, moist/clammy, shiney (sp?), no edema. Her skin on the upper part of body (shoulders, neck, face) has turned really red....can someone explain Way this is happening? I thought maybe the heart is pumping so hard to keep pressures up & keeping blood & oxygen to the major organs????? I don't want to sound dumb but I don't understand this. Since her admission on Wed night her tube feedings have not been re-started.....she is getting IV fluids, but shouldn't she be fed too? Thanks for helping me understand this.

[meownsmile, BSN, RN]

The reason feedings havent been restarted is because it takes energy to digest and blood pressure to help circulate the nutrients being extracted from the feeding. So if feedings are restarted it could just speed up the inevitable and you would have major issues with liquid stool and skin burn from the stools. So comfort wise, it is better that they arent getting the tube feedings.

The redness in the face/neck/shoulders may be from capillary breakdown. Similar to the mottling that people get in the lower extremities prior to death. It could be that her natural coloring is somewhat ruddy and you are just noticing it more now because the blood pressure is low and the capillaries are oozing into the interstitial tissue.

I dont know,, just a shot, ask the doctor next time he/she is in,, but they may not have an answer for you either.

[crb613, BSN, RN]

Thanks for the help. The Pt is my MIL & it is kinda hard to think clearly w/someone so close to you. Everything you said....I guess I knew, but just wanted to hear it from someone else. I just kept thinking are we starving her too..... All fluids, abx have been stopped. Now pain & temp control are the goals. Thanks again.

[ktwlpn, LPN]

QUOTE>Thanks for the help. The Pt is my MIL & it is kinda hard to think clearly w/someone so close to you. Everything you said....I guess I knew, but just wanted to hear it from someone else. I just kept thinking are we starving her too..... All fluids, abx have been stopped. Now pain & temp control are the goals. Thanks again.QUOTE> I am sorry for your MIL's illness.It is tough when it's your own family in that bed but it makes you a better nurse.When you have time please search the hospice forum here .This subject comes up time and time again and nurses way smarter then me have debated it.I don't believe you are starving your MIL at this point.I've seen that tube feeding at the end of life actually causes discomfort because it increases oral secretions and as the body shuts down the TF is not going to be digested so you can have vomiting and aspiration.In my experience a "dry death" seems much more comfortable..Also -she is past the point of actually feeling hunger.You are helping to ease her into the next phase of life in a natural way...With dignity and without pain and you and the rest of her family should be commended for helping her.Take this time to talk about your own advance directives-the greatest gift we can leave our loved ones is the gift of knowledge.They need to know what our wishes at the end of life are so they can be our advocates...Good Luck-I'll say a prayer...

[crb613, BSN, RN]

ktwlpn...Thank you so much. She died today about 11:30. Her family was with her, we told her to go we did not want her to suffer anymore. She took two breaths & was gone.....very peaceful.