Withholding food and fluid in a dying patient

[CapeCodMermaid]

OK...here's the story....the patient has end stage Alzheimers disease and has lost the ability to safely swallow. The speech therapist has recommended she be NPO because the risk of aspiration is so high. The family agrees and doesn't want us to feed her and they DON'T want a GTube or IV fluids. The woman is on hospice services in my facility.

I have no problem with end of life...the woman has no quality of life at all, but is is legal to have an order to withhold food and fluids?? Wouldn't it be better to write an order "diet as tolerated"? Any legal eagles out there?

[BRANDY LPN]

did your pt. have dysphagia? if not, then that's fine. but if he did, how did he tolerate the steak dinner?

leslie

No he didn't, he had hep. failure and renal failure, and so was on a low protein diet. (if i remember right not sure it was a LONG time agon.)

[Laurell28]

From the original post I swear you were talking about my grandmother, but we are not near Cape cod.

My grandmother died Saturday morning. She had been in nursing home hospice for many months. She LOVED ice water and ice cream her entire life. At one point she had a barium study that indicated she was silently aspirating some of her intake. The swallowologist in the nursing home tried to make her NPO. At the time she was getting nothing, but was still able to immensly enjoy cold water and ice cream. We had to fight with the some of the staff at the nursing home to get her what she WANTED. She absolutely did not want anything that had Thick It in it, because she would not ever have the second spoonful. The MD agreed with how her end of life care should meet her basic needs, and that was with ice water/ice cream, which is was she got until she was unable to. It made her eyes light up so much.

It is detrimental that we are able to identify what will happen to the patient/family member regardless of what we as nurses are capable of doing. Please let people enjoy what remains of their life, while they can.

I'm so sorry about your grandma. As a hospice nurse I stay far away from NPO orders for the very reason you just expressed so clearly. What my patients want they get. And we also honor if they dont want anything. I've seen many "ice cream smiles" even if it was just tiny bites on the end of a spoon.

[Bird2]

I'm so sorry about your grandma. As a hospice nurse I stay far away from NPO orders for the very reason you just expressed so clearly. What my patients want they get. And we also honor if they dont want anything. I've seen many "ice cream smiles" even if it was just tiny bites on the end of a spoon.

We have had families/residents sign releases that state that they are aware of the consequences of not following the prescribed diet. I agree that NPO can be wrong for some residents. If the end of their life will be better with food or fluid they should get it. If they aspirate there are meds to make them comfortable such as Robinul. We have many care plan conference with family and Hospice so all options are on the table.