Need an experienced opinion please!

Nurses General Nursing

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I've only been a nurse for a little over a year and I don't have a lot of experience with death and dying. A family member of mine was in the hospital for a few weeks. He is 78 years old and has every health problem you can think of. He has had previous MI's and was in the hospital for this again. The doctor told him that he only had 20% heart function and his kidneys were failing. He told him that he wasn't going to make it. He was discharged to a nursing home and is currently there. He is in another state, so the only information I get is from my other family. I can't see him, so I'm only going on what I have heard. He has been in the nursing home for about a week now. At first he was doing really bad and they thought he wasn't going to make it through the day. Well, I just found out today that yesterday he was getting "better". I know he has CHF and they said his breathing is better and he has had some urine output. How much? I don't really know. A few days ago it was scant. Now, it could be 100cc/24 hours. The edema in his legs and arms is still the same. He is still A&O, he has been throughout. I'm told that he is very tired and sleeps most of the time. He eats just bites and only takes sips. He is also very weak and doesn't get up. I guess what I'm asking is.....Is he going to get better? How can someone live with only 20% heart function? Or is this something that usually happens? That patients get a little better before they take a turn for the worse and die? I just want to know what you think. Help please!

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are you talking about 20% ejection fraction? yes, i've had pts with ef's that low; and of course he's tired because of the diminished cardiac output. you reallly don't give enough info re: his renal failure. is it end stage? is it just the beginning? chronic? depending on what stage he's in, renal failure can exist for yrs. again, i'm sorry but only labs and a talk with his md will help you in assessing his situation.

much luck to you.

leslie

edited to add that i just reread the post and his uo was 100cc/24hrs. to me, that sounds like esrd. again, have a close family member have a talk w/his doctor and see if he's a candidate for hospice services. God bless.

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Specializes in tele, stepdown/PCU, med/surg.

He may get better for a little while but CHF is a chronic, progressive disease and I agree with Leslie about getting hospice involved.

It has to be so frustrating with him in another state and getting info from other family. I'll keep you in my thoughts.

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Thanks for the advice, that was what I was thinking, too. To answer some of the questions, I'm not sure if it is end stage renal failure or not. I know he has had renal failure many times before so I know it isn't the beginning stages. He is in another state so I can't look at him and his chart to assess him. I can't talk with the doctor b/c he is in another state. All I can go on is what my family members tell me. The doctor told him he would not make it so they put him in a nursing home. He has had CHF for a long time, probably more than 15 years. I know the diminished output makes him tired, but what I don't understand is if the heart only has 20% ejection fraction, how can it keep going on like this? And how long will it keep going with very little output from his kidneys?

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Specializes in Case Management.

Low dose dobutamine infusion can help with renal and cardiac perfusion. I have had several patients maintained as outpatient with end stage cardiomyopathy and end stage renal failure with low dose dobutamine continuous vs periodic infusions as outpatient.

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but please, before considering dobutamine or other life extending interventions, it sounds like someone needs to assess his quality of life. if he sits or lies down all day, edematous. fatigued and generally uncomfortable, these all must be considerations too. i think you need input from his doctor first and foremost.

leslie

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He is at the end of life. Perhaps a hospice care thread is in order. I'll pray for you both.

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He is at the end of life.

it certainly sounds that way sfcardiac.

it also sounds like it's time to start making this gentleman more comfortable.

leslie

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