Question - about sick grandmother

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My grandmother is dying of esophageal cancer. The doctor gave her about 8 weeks to live in December, but she is till with us. She has hospice care at her nursing home. She is really unable to eat anything and when she drinks it just pools up in her throat and she ends up throwing most of it up. They suction her on a pretty regular basis. She has aspiration pneumonia, but it doing okay all things considered. She had the rattle but that all stopped with the scope patch. My question is why don't they start an IV to hydrate her. Her output is scant since she can barely swallow. I know she is dying and I am okay with that, but in my little nursing student mind I am going "shes dehydrated we need to get some fluids in her". I know how miserable I feel when I am dehydrated, and have chapped lips, dry mouth etc.

Thanks in advance

jen

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My grandmother is dying of esophageal cancer. The doctor gave her about 8 weeks to live in December, but she is till with us. She has hospice care at her nursing home. She is really unable to eat anything and when she drinks it just pools up in her throat and she ends up throwing most of it up. They suction her on a pretty regular basis. She has aspiration pneumonia, but it doing okay all things considered. She had the rattle but that all stopped with the scope patch. My question is why don't they start an IV to hydrate her. Her output is scant since she can barely swallow. I know she is dying and I am okay with that, but in my little nursing student mind I am going "shes dehydrated we need to get some fluids in her". I know how miserable I feel when I am dehydrated, and have chapped lips, dry mouth etc.

Thanks in advance

jen

jenny,

i'm really sorry about your grandmother. i'm afraid that there really would be no purpose in iv hydration because it's only a temporarily measure. once they stop the iv, she would just go back to her inability to eat, drink. this cancer is in her throat. it bothers me that she's eating and drinking; suctioning is not comfortable and it would be much more uncomfortable for her, should she aspirate and get aspiration pneumonia. in spite of what you've heard, dehydration is not uncomfortable. your body releases endorphins (a feel good hormone) when it's in a dehydrated state. it's also quite natural for someone with cancer to have a significant decline in appetite. good mouth care will help the chapped lips and dried mucus membranes. there's a lot that can be done for your grandmother to make her comfortable. hydrating her, unfortunately, wouldn't be one of those intervention. again, i'm sorry.

leslie

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jenny,

i'm really sorry about your grandmother. i'm afraid that there really would be no purpose in iv hydration because it's only a temporarily measure. once they stop the iv, she would just go back to her inability to eat, drink. this cancer is in her throat. it bothers me that she's eating and drinking; suctioning is not comfortable and it would be much more uncomfortable for her, should she aspirate and get aspiration pneumonia. in spite of what you've heard, dehydration is not uncomfortable. your body releases endorphins (a feel good hormone) when it's in a dehydrated state. it's also quite natural for someone with cancer to have a significant decline in appetite. good mouth care will help the chapped lips and dried mucus membranes. there's a lot that can be done for your grandmother to make her comfortable. hydrating her, unfortunately, wouldn't be one of those intervention. again, i'm sorry.

leslie

i'm sorry jenny.....i didn't see the part where she had aspiration pneumonia. oh God, please, if people are trying to feed her, have them stop. with all the suctioning she's getting, it's because she has profound dysphagia. the kindest thing you could do is to make sure she's not being fed against her will. if she wants to eat or drink, that's wonderful...but make sure that the food is pureed and the fluids are thickened.

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Thanks a lot for your reply.

Jen

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When pts can't eat, their albumin levels are very low. Thus, they usually are not able to retain IV fluids in their vasculature, because of low intravascular colloidal oncotic pressure. This usually results in severe edema (anasarca), impaired tissue integrity, and pulmonary edema.

Very uncomfortable. As a former inpt hospice nurse of four years, IV hydration in pts that can't eat is usually only done because a family that does not understand what is going on w/ a pt physiologically, insists on it. IMO, it is much more humane to avoid IV fluids.

I'm very sorry about your grandmother's illness. I wish peace and comfort for your grandmother, your family, and you.

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I agree with the other posters -- good mouth care will keep her more comfortable than IV hydration (which will just prolong and make more uncomfortable the inevitable). Too often in similar situations, interventions are done for the family's comfort, not the dying patient's. Best wishes for your difficult and painful situation, and a peaceful and comfortable passage for your grandmother ... :kiss

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