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Thank you all again.. just one last update.. my grandfather passed away Tuesday morning... over the last few weeks his dementia got worse.. he started hallucinating and forgetting who we were and really wasn't eating... my family was with him on Father's Day and he had a very good day.. on Monday my grandmother called me crying because the nurse at the rehab had asked about a dnr Sunday night and even though she hadn't agreed to the dnr she had come to terms with him being so sick... then Monday morning we got a call that he had been found unresponsive and they had started cpr.. he was pronounced in the rehab and looked so peaceful... like he had just closed his eyes to rest... my grandmother later said to me, "thank god we didn't do dialysis.. it would have been too much" ..I was so glad she was at peace with it and felt that his last few days were good ones.. thank you all for your support and for helping my grandfather be pain and suffering free as much as he could have been... thank you.

Update: I was able to speak to my grandfathers primary doctor for this admission and told him about our dislike of how pushy the nephrologist was being and asked if it was worth talking to a different doctor. He initially said the result would be the same and that my grandfather would need dialysis eventually. When I told him that he was scheduled for permacath placement and for dialysis to start before the end of the month he gave us the name of a different nephrologist and called him to come see him. It is such a difference! He sat down with my grandparents... actually sat in he hospital room... and closed the door so they couldn't be interrupted and spoke with them for an hour... he sees the whole picture and is worried about his quality of life! It's amazing how much a good medical professional can set your mind at ease.. thank you again for your advice! It helped me stick to my gut and push for what is right for my family! It will still be a tough choice when we have to make it but at least now I know we have a doctor who has his best interests in mind... thank you thank you thank you

Thank you all for responding... I wish my grandfather still had the mental capacity to really tell us what he wants but after these last 2 rounds of hospitalization and now being in rehab his mind hasn't returned to baseline. His kidney doctor pushed my grandmother and my mother and they now feel like if they don't start dialysis they'll be killing him and that they have to do something. Based on your advice and knowing my grandfather I really don't think dialysis is the right thing for him but this doctor is promising miracles about his mental status returning to normal and his activity level increasing and his chronic pleural effusion and heart failure going away and so family has chosen to move forward. He had a chest X-ray for pretesting for permacath placement and they found he has too much fluid on his lungs for him to stay in the rehab and are sending him back to the hospital. It's like a nightmare. I feel like I have become the advocate for death but all I want is for him to be comfortable and at home and to not live whatever time he has left in and out of one medical facility or another. thank you all again for your advice and for taking the time to answer me.

This may not belong in this section but I'm not sure where else to put this.. I'm a medical ICU nurse so my main experience with dialysis is emergent/ temporary... anyway.. my grandfather is 85 with heart failure (ejection fraction 25%), asbestosis, chronic pleural effusion, a touch of dementia and now kidney failure... he still urinates and he doesn't have electrolyte imbalances yet but his creatinine is 2.8.. his new nephrologist is pushing dialysis and I'm just not convinced it will be good for him.. any dialysis nurses out there with experience with patients like this starting dialysis? I almost fee like my family is being guilted into it because "if we don't do anything he'll die" but everything I've read out there on the topic says the outcomes for patients his age with multiple comorbidities like he has says they don't do well and it doesn't help... just looking for actual experiences.. thank you!

Hello, i love this site and the great advice that can be found here. I couldn't find someone else with this question and so this is my first post. I've been working in my first nursing position for over a year (not counting the first few months of orientation) on a step down telemetery unit and while I love my job and my coworkers, a true critical care floor is where I want to be. My floor has been unable to keep new nurses for very long and quite a few of them feel betrayed by my leaving, which I can understand, but ultimately I have to follow my dreams. I will be staying with the floor on a per diem basis and I have become friends with many of the nurses, assistants and secretaries. I want to do something to show them that I appreciate them and everything they've done to help me get to where I am now. Any thoughts?