Question about Hospice and D/C of meds

[RFederer]

I am a student nurse on rotation at an extended care facility. I was assigned a patient with Huntington's Disease. He is in he last stage of the disease, but alert and oriented although he can only respond in one or two words. He seemed to be doing well except for a bout of C-Diff which most of us beleive to be cleared up. His family has pretty much abandoned him, no visits, no contact. The patient is isolated the majority of the time, as are the others. (we are not in the best facility as you might have guessed) My question is, last week he was put on hospice. When I was passing meds, everything in his chart was d/c'ed except the antibiotic for the C-Diff and Akwa tears. Even his PRN pain meds like simple Tylenol were d/c'ed also. His glucerna shakes for extra calories were discontinued (people with HD can burn up to 5000 calories a day) He has become even more withdrawn and not interested in eating. He was on some pretty powerfull drugs, including 150mg of Effexor XR that he had been taking for the last 5 years. Instead of weening him off these meds, they just upped and stopped. Is this normal?? My pt. the ther day complained of being in A LOT of pain. I myself had to be weened off Effexor and it was not pleasent. Pain, brain shocks etc. Do they just stop meds when you go into Hospice?? They won't even give him anything for pain. The nurse said it may be the family's choice to do this. I can't see how you would let a pt. die in pain like this. I was just wondering if this is a normal accurance with Hospice? I really feel for my pt.

[RFederer]

No I am not certified as a CNA.

Then you have an ethical dilemma, don't you? Report the abuse, as you will be required by law to do when you are licensed, or ignore for the sake of your nursing education.

Did you do the CNA course and/or were you ever certified as a CNA? If so, I believe you are a mandatory reporter.

Reports of abuse to the Ombusdman's office are confidential unless you give permission to be identified.

[leslie :-D]

No I am not certified as a CNA.

to me, it still remains a highly ethical dilemma, whether you're mandated or not.

there are (too) many mandated reporters who still choose not to disclose.

whatever you decide to do, just keep in mind that a report would be confidential and couldn't be traced back to you.

don't talk to anyone about it.

but please, do consider doing it for the sake of this helpless soul.

leslie

[rmarz]

A common trend I have noticed with nurses that I work with: They hate to make phone calls.

I admit I was kinda scared of picking up the phone and talking to someone, such as a hospice nurse manager or a doctor when I first started.

Its possible the charge nurse you talked to that had this resident falls into that category. All the nurse has to do is pick up the phone and the problems would be solved quickly.

Unfortunately I see this a lot. New grads et experienced nurses alike sometimes seem allergic to making phone calls et expressing a situation in a way that gets the desired results. People do often make you feel stupid when you call them. I think thats one of the finer points of nursing... being able to call someone up and get exactly what you want even tho they have to be the shot caller on paper!

[leslie :-D]

stormy, i just wanted to address your disillusionment with nursing...

that you thought all nurses were supposed to be compassionate, caring, etc.

while most people do have that delusion about nurses, you will come to realize that we are human beings first and foremost:

and enter nursing for a variety of reasons...

not always to be altruistic.

frankly, you will see things in nsg that turn your stomach.

you will see laziness, backstabbing, apathy and other alarming qualities.

but for the most part, you will come to appreciate that most of us do care.

despite the tremendous stress levels and obstacles, many of us come home sick and wiped out, only to vegetate the next 3 days we have off.

you will also see nurses stepping up to the plate as well as others turning a blind eye.

for those who look the other way, it is mostly related to fear of recrimination.

and yes, that happens to.

so as you enter your new journey, you and only you, can decide what battles are worth fighting.

but if you choose to take a stand, just remember, it doesn't always have to done in the grand scheme...

that your 1:1 with your pt, often is enough to make a world of difference.

so don't remain discouraged.

when your time comes, you will indeed be in a position to make a difference.

it doesn't matter if it's on a macro or micro level.

but be assured, you will learn how to advocate and be a leader in your own right.

that's what makes ea of us so wonderfully unique:

that we learn how to use our God given talents, in attempts to bring about change,

for our pts, for ourselves, for our environment.

trust me, you will spread your wings and soar...

and only then, will it be your time to shine.

hang in there, sweetie.

we need you.

leslie

[ktwlpn, LPN]

that's a good idea, except i'm wondering what their response time is?

only reasoned i mentioned ombudsman was likelihood of someone coming immediately to investigate.

public health would likely take weeks...

leslie

Our DOH must respond to any complaint within 48 hours.Our local office has really worked well with our administration in the past in situations similar to this..They have found that we MUST consider the residents needs ahead of the families demand.Too often families have crippled us by trying to control their loved ones care plan for whatever reasons-guilt,anger,etc. and make is impossible for us to treat their loved one to the best of our ability.It's too sad...

[ktwlpn, LPN]

Yes I too was surprised as why he was put on hospice. Honestly, I feel they are just trying to off him. He is still brought to the dining room to eat pureed food and was admitted in 2003. He was walking up until 8 months ago and driving right before he was admitted. His primary admittance (so it says) is BPH and UTI. I am quite confused. Thank you for further educating me on HD. Does anyone know why the pt.'s scream towards end of life?

I don't think anyone wants to "off" him.If he is having trouble swallowing, has a history of aspiration pneumonia and an advance directive stating "no tube feeding" then hospice may be appropriate. He could stabilize and live years or he may not.In his place I would opt for hospice which for me would include no antibiotics-I would not want to live in LTC,dependent on others for all adl's.Others disagree.

[CT Pixie, BSN, RN]

posted in wrong thread...oops, sorry!