'Scuse me sir, don't bite into that frito ! ! !

[CaLLaCoDe]

One issue I think is awfully odd; I know it really is meant to be benificial is putting a patient on a strict diet (let's say low sodium, diabetic, renal etc). I could understand why this is done; however, if the patient complains and is sneaking food on the side what good does this dietary solution for a short while do anyway?!!! D/C'd today to sin tommorow!?

I can't tell you how often I've seen patients' families cart in heavy leaden doughnuts for breakfast when the patient is on a diabetic diet; I know that education is valid at these moments but when it happens again and again...with candy falling out of the bedside table..filled to the brim with goodies and soda bottles everywhere! What is this all about? Why should we have to be the P*O*L*I*C*E for a patient's life choice?

[santhony44, MSN, RN, NP]

This may be a little off topic but I remember a poor little 88 year old lady that was taking "too many pain pills" according to her daughter. The daughter lived out of state and made an appearance when mama was sent from the nursing home to the hospital.

She stayed on the doc's back about drying mama out and the whimp went along with it.

That poor woman!! It was pitiful.

I say, if you are over 85 and you want to eat cheeseburgers and shoot heroin........go for it. (a little extreme, but you get my point)

I agree with you on that!

I remember one long-term patient with Alzheimer's who basically sat in a chair all day. She was past talking, much less doing anything for herself. However, she ate when fed and made "mmmmm" noises. It was obvious that she could still taste the food and got some level of enjoyment from it.

Her daughter decided "Mama is gaining too much weight, her clothes are all getting too tight." Mama was maybe 150 lbs.

She came in one evening during supper and made the aide take the tray away before her mother was finished. The aide came to me with the tray. I told her to put it aside for now. When daughter left, we warmed up the tray and the aide fed the patient the rest. We may have even added an extra ice cream or something.

I think the patient lived less than a month after that.

Why take away the one thing the poor lady still seemed to connect with and enjoy?

[twinmommy+2, ADN, BSN, MSN]

I like the one who was just put on an NPO diet since he was going to have an I&D done later that day, explain this to him in length, then return with the surgical consent form, and find him with his family and a huge donut in his mouth just as happy as a clam. The family was very suprised as he just told them to bring him something lol.

[AuntieRN]

I agree with leahjet...

My gram is a diabetic...she is also almost 90...If she asks me for a snickers which is her favorite I let her have it...my family has a fit...they ask me why I am trying to kill her...I am not trying to kill her...for heavens sake she is almost 90 why change how she lives and eats now...she has made it just fine this long...let her be happy....

[UKRNinUSA, RN]

I think sometimes you just need to be blunt to get your point across, but sometimes even that doesn't work. You can educate them on the consequences of bad choices but the rest is up to them.

I had an asthmatic patient who was very allergic to cats -his s.o. had recently acquired a kitten and he had his first attack in years. I warned him that either the kitten or the s.o. had to go and meanwhile should his symptoms recur he should immediately seek medical care or else he would end up either on a ventilator or dead. He chose to ignore the instructions and ended up dead a week later from respiratory arrest.

[CaLLaCoDe, BSN, RN]

[mouse]

her daughter decided "mama is gaining too much weight, her clothes are all getting too tight." mama was maybe 150 lbs...

why take away the one thing the poor lady still seemed to connect with and enjoy?

[/mouse]

i think this hits at an issue we as professionals struggle with, the autonomy of the patient versus the desires of the nurse or in this case, the family! to live your last as you see fit? wow, what a nursing staff!!!

looking at another perspective:

i agree bluntness is great, ukrninusa! when to use that bluntness without it backfiring on you, as it unfortunately did with this dude is case in point...but, i do think he needed to hear the truth before he put the anaphlylactic bullet to his head.lol!

[Antikigirl, ASN, RN]

OH my favorite is someone NPO for a treatment, and I catch them eating/drinking and we have to delay treatment (or even surgery) and the MD yells at ME! Uhgggggggg! Had it happen a few times, I basically say "I caught them didn't I, better I had then it not have been caught? I am not their 24/7 in room RN...they were instructed not to ad nauseum...what more would you have me do?". (we also get red signs all over in different languages too that say NOTHING to EAT OR DRINK!!! TREATMENT PENDING!. Oh well...I can't do much more than that unless they want to hire a sitter?

I tend to explain in full WHY they are NPO or on diet restriction..and what we have to do to overcome a cheat on diet. Typically I hit the old money belt with this one...more days in hospital, more medications to reverse the damage, and the possible...ohhhh funeral bill? That also works for the constant family "well they need to eat...". Oh they get a nice lecture from me starting out with something akin to "where did you get your medical degree" or "then why are they here then if we are not to treat them according to what is necessary?".

For pts that are going to cheat and not going to listen...I talk with the MD and say...Look, here is the situation, can we comprimise a tad...a give and take on both sides? That usually is a good way to go!

[MrsJCP]

What I find the most annoying is that these pts don't do what they need to to stay healthy, and then come back again and again. Then when we are caring for them they complain about being there. If you don't want treatment, DON'T COME IN!! Or atleast save us all the trouble and make yourself a DNR-DNI. I may sound a little hasty but I get soooo sick of this. I'm not a babysitter to those who can't lay off the liquids and salt. Whew, thanks for listening while I got that out.

[jimthorp]

I care for someone who does not have a clue why she is on any dietary and fluid restrictions and neither does her out of touch, spacy daughter. This woman has chronic high blood ammonia that is controlled with lactulose and diet. This daughter sent her mom a care package loaded with cheese and mind you this person would eat the plate if you let her. Needless to say a day later she was in the hospital with ammonia level >150.

I'm to the point now I just don't care about these people and families who insist on constantly breaking the boundaries of their treatment modalities and chart everything.

[Soup Turtle]

My grandma's had both legs amputated, strokes, goes for dialysis three times a week, is diabetic, has a bad heart, etc. She begs for cookies, candy, ice cream and cheeseburgers whether she's in the hospital or at home. We always get her what she wants. She understands she's not supposed to have it, but she doesn't think she's going to live long regardless of what she eats or doesn't eat.

[lllliv]

i believe patients should be able to refuse to be on a special diet. they will do what they want when they go home anyway. it is their right/choice.

[lsyorke, RN]

Kind of similar, why put a 94 year old Alzheimer's patient on a low fat, sodium restricted diet? They'll live just fine on cookies.

roflmao!! OK, this one struck my funny bone!!! I'm so with ya!!!:)

[carolinapooh, BSN, RN]

Kind of similar, why put a 94 year old Alzheimer's patient on a low fat, sodium restricted diet? They'll live just fine on cookies.

Glad to see that I'm not the only person who finds such action ridiculous....