old lady feel like I am starving her

[ulmaulma]

OK here goes .. English is not my first language so bare with me;-) I had this old lady come up to my ward the other day. less than fourty pounds with pneumia. Shes been fine and taking care of herself until five weeks ago. She´s 96 can´t swallow at the moment do to infection and apoplexia. She´s clear in her head, vitals fine, pees like a winner and so on ( english hmm;-) shes complaining about thirst gave her an iv. now says shes hungry ( wonder why having been feed for days) doctors thinks shes "do"don´t want anything invasive but that was days ago.....she keeps telling me shes doing better AND I can tell the other nurses says no but what do I do??? I am I just to sensitive ( new grad) but she looks like she needs iv ab/flurids and nutrison AND being asked herself about the whole thing! feel like I am starving her!! This is geriatrics wonder why cause usually we won´t even let cancer patient with cardiac arest die HMM..

[Dolce, RN]

Sounds to me like she needs a dietary consult. They would be able to evaluate her nutrition needs and to make sure that they are being met.

[Riseupandnurse]

You need to speak with your head nurse tomorrow and if things don't straighten out right away go to your ethics commitee.

Dietary can help, but this woman can't wait.

[kstec, LPN]

You're the patients advocate. If she voices she wants food and doesn't want to starve to death or has a prognosis that is good, go to anyone and everyone who will listen to get either her food or a good answer for her not getting nutrients. If it doesn't feel right, then follow your gut until it does. Just because a MD says something, it doesn't mean its law, don't ever be afraid to question them in a professional matter. Just remember, you're her voice, speak up for her.

[ulmaulma]

thanks for your replays! This is always hard. the lady had a stroke years ago,know unable to swallow. came in five days ago, 96 years old weiging well maybe 35/40 pounds. Known with cardiac disease, had the pneumonia. She got the dnr right away and the doctors had pretty much given up on her, do to her poor state and prognosis( she looked pretty much dying to me too). This is common practice and I am usually fine with that. BUT five days after her vitals were fine, she complaint about thirst ( had an i.v. with fluids) but hunger? and trying to tell me she was ok, like she "wasnt ready yet" ...ahh, probably could not save her, BUT at least try to meet her needs. THEN again, maybe it would also be unetichal to give her a central line for nutrison or a feeding tube with the risk of complications...don´t know and doctors would disagree, she really made me feel bad eitherway..she probably isnt there when I get to work, I guess she did give me something to think about and the way I practice nursing and I thank her for that

[birdgardner]

"the lady had a stroke years ago,know unable to swallow."

If the patient had a stroke years ago and has not been able to swallow since then, how has she been getting her nutrition and why has that means been stopped. It sounds like you definitely need to advocate for her and fast.

[ulmaulma]

thanks for your replies I can tell that u all feel the same ..I should speak up for my patient! I work in geriatrics and we deal with this all the time. Sometimes I even feel it´s unethical with tube feeding or a centralline...it all depends as you know. Haven´t been to work since I wrote the last post but heard from a co worker that the patient is going to be okay, they r even considering tubefeeding ( WOW)...i do love where I work but this has been a case of considering age and feelings over ethics and medical knowledge. I will bring this up to discussion in a doctor/nurses forum where I work to evaluate this case, and know that when my gut feeling says yes it usually is a yes nomatter what coworkers says.