Author Topic: Pneumonia, lack of food and fluids - How long to live?  (Read 4754 times)

myrockfight

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Pneumonia, lack of food and fluids - How long to live?
« on: December 18, 2008, 11:38:47 PM »
Bad news. My grandmother is in hospice. She contracted pneumonia again after breaking her neck and her nose after falling out of bed. Apparantly, in Florida, there is a law against putting the rails up on the sides of beds? The most ridiculous *expletive deleted*it I have ever heard. She has been off mentally since she had a stroke last December and she thought she could walk and just hopped out of bed. Well. Maybe not hopped. That is the supposed story. You never know.

Anyway. My Dad made the decision to not send her to the hospital this time. Her quality of life is very poor. She can't walk. She hallucinates and is delusional (massively). Most of the time she thinks she is living about 40 years ago and working back at the family restaurant in Canton, OH. (Papa Bear's, if anyone is from there). She also hallucinates about watching a new born baby, going all over the place (getting her hair and nails done, visiting family and friends (many of whom aren't living anymore) etc.)

So I was wondering how long someone can reasonably last without the feeding tube. I don't think she will be getting fluids anymore either. 24 to 48 hours. I thought that it would be longer, but I don't know with the pneumonia. I just worry about her suffering. Surely they will keep her medicated enough to deal with that.

Azrael256

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #1 on: December 19, 2008, 12:05:59 AM »
My mother used to moonlight with a home hospice service.  They are *VERY* liberal with the morphine.  I can't say how long it will be, but they are serious about the no suffering thing.

RaspberrySurprise

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #2 on: December 19, 2008, 12:10:46 AM »
Ehhh, nevermind.
« Last Edit: December 19, 2008, 12:21:56 AM by RaspberrySurprise »
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Lee

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #3 on: December 19, 2008, 12:14:42 AM »
I'm sorry to hear of her situation.  From my experience with my dad....she probably has 48-72 hours.  It's tough to go through.  Tougher for the family than it is on them.  All one can hope for, is that they will soon be united on the other side with those they loved. I believe that is true.

Monkeyleg

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #4 on: December 19, 2008, 12:18:47 AM »
Been through it a couple of times now.

The morphine really helps. Once she stops eating or drinking, it's a matter of two or three days.

When my dad stopped eating, I knew that was it. He died two days later. Same with my brother and my father-in-law. Two days.

I'm sure you're hurting. Just remember that she'll be in a better place, free from the misery she's going through now.

jackdanson

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #5 on: December 19, 2008, 01:17:38 AM »
Sorry for your loss.  My sister is a hospice nurse, just try to keep your grandmother comfortable.  There is no way to know for sure how long she will last.

Don't care

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« Reply #6 on: December 19, 2008, 01:38:58 AM »
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« Last Edit: February 19, 2009, 02:28:29 PM by Don't care »

Bogie

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #7 on: December 19, 2008, 02:10:14 AM »
We've got the tech to keep the body alive far beyond what it is supposed to be able to stand... My father has lung cancer. He took care of my uncle, who died of lymphoma. He's got emphysema and COPD, and has decided to avoid any and all treatment and surgery, and to just check out naturally, hopefully gliding on a good morphine buzz.
 
I don't think I'm going to handle it well. I haven't had enough time with him.
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Don't care

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #8 on: December 19, 2008, 04:42:57 AM »
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« Last Edit: February 19, 2009, 02:27:06 PM by Don't care »

myrockfight

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #9 on: December 19, 2008, 05:45:14 AM »
We've got the tech to keep the body alive far beyond what it is supposed to be able to stand... My father has lung cancer. He took care of my uncle, who died of lymphoma. He's got emphysema and COPD, and has decided to avoid any and all treatment and surgery, and to just check out naturally, hopefully gliding on a good morphine buzz.
 
I don't think I'm going to handle it well. I haven't had enough time with him.

I'm really sorry to hear that. Given standard circumstances, I think it is harder for people to deal with the death of their parents. This is my 3rd grandparent to go. The first two were the most influential and closest to me since my parents were divorced when I was 2ish and they stepped up as stand-in parents while my parents got their lives back together. Although it hurt to see them go, the time that I spent with them really helped me understand how important family is from a young age. I feel very lucky and blessed to have come away from that with a huge amount of respect and consideration for family. I can't say that I have any regrets now with respect to how much time I have spent with them before they passed. There has always been a lot of time allowed for spending time with all my family. I don't know if it was more nature or nuture, but I've always been aware of how many people don't get to spend enough time with someone before they pass. Maybe it is just me, but I have heard that so much it has come close to making me paranoid. However, it wasn't the fear of that which drove me to spend time with my family members. I've just always really enjoyed everyone. For that I feel blessed. And honestly, for all the time that I have spent with them and made for them (which honestly was a lot and mostly unparalleled in my family with the exception of my cousin), I still feel like I could have done more. It seems to be the nature of the beast.

Bogie, I know that your Dad's passing will be really hard on you. But I must say that knowing that it is coming makes a big difference with the way that you are given the opportunity to deal with the situation. Don't get me wrong. I know it will probably be one of the hardest things you'll deal with in your life, but it will definitely be better than him just strolling through life and then getting yanked out by fate/circumstance/whatever you want to call it in a short lived event. My other grandmother passed like that and it was really hard to deal with. Coupled with the fact that she was literally the kindest person I have ever had the opportunity to spend time with - it was hell dealing with the emotional aftermath. It took me years to be able talk about her without getting worked up about it. It is really hard to accept when given that sort of situation.

In contrast, my grandfather was in and out of the hospital and was having a hard time of it when he passed. Just because it was not completely unexpected, made a big difference. Even considering how close I was to him, it was less difficult to deal with my feelings.

I had made a point to go back up to Ohio to visit with him, play golf/guitar together, and document his childhood days during the depression by photographing the places he lived and worked, etc. and listening to him talk. He was farmed out to family and had a pretty rough time of it because his father died when he was 5. But he had built up a good life for himself. I was always really proud of him and took a lot of pride in how much I took after him.

Our handwriting was so similiar that I couldn't tell the difference sometimes. I didn't realize it until I came across a crossword puzzle book that was half filled out. It took about 90 seconds after trying to remember when in the hell I filled out all of them, that I realized the obvious, but unlikely.

One of the proudest moments of my life was seeing the smile on his face when I pared two holes in the first game of golf I had ever played (and the first day I had really swung a club). Boy did he brag on me about that. And I basked in the glow of his attention. He was a somewhat hard fellow and wasn't easily impressed by much. Never gushed about anything and was really reserved with his feelings and affection. So it was a big day for me and I'll never forget it.

One thing I can say. Talking about this stuff really helps me deal with it and put my feelings into words. When your Dad does pass and you are at his funeral: Get up and say something about what your father meant to you. It is not a tradition in my family to do so at funerals and I have never been to one where someone other than a preacher, said something about the passed relative. It took a lot of pulling myself together emotionally and getting up the gumption to ask to do it at my grandfather's funeral. But it helped me a lot. All I could think about was how no one who knew my grandfather was going to be speaking about him. "What in the hell do they know about him?" The preacher was really nice who spoke and didn't use it as an opportunity to advertise for his own congregation for once. But he didn't know him and the words seemed empty to me. My grandfather was a great man and deserved more than that. I was damn near falling apart while speaking, but it gave me some closure and I guess I felt like I gave a little back. I don't know all what it did for me, I'm no psychologist. But I said things that needed to be said and no one else was going to do it.

Give it some thought and a shot if it strikes you when the time comes. It took me a few minutes to come up with what I was going to say, but it came together nicely and I didn't have notecards or anything. You know your Dad. You'll know what to say.

Of the years I've spent in hospice care nursing, both private duty and facility, I want you know that I empathize with you and your family. I hope that your family will take full advantage of hospice care, that includes such services as counseling before and after your Grandmother's passing.

While I don't live in Florida, I suspect you are being misinformed. Generally speaking, It's unlawful to fashion restraints without a physician order, but not safety or positioning devices. Please contact your hospice case worker for a physician order for bedside rails if required. They are there to help.

I am not licensed to practice nursing in Florida. Don't construe the following as advice or anything that could be interpreted as practicing nursing. Okay? Call your hospice case manager to get the information you require.

In as so far as her hallucinating, if she appears to be enjoying her time, it ain't a bad thing for her. Be thankful that she isn't having nightmares, regardless of her state of awakening or sleep. Play along with her, it will make life more pleasant for her.

Depending upon how advanced her terminal illness, as well as her pneumonia, time without fluids can be a matter of hours.....or approach almost a week. Sorry. The G tube is a medical device of great controversy in many instances. Keep it in to just administer pain relieving medications, but make sure to keep it patent with a minimal water flush.

Watch for her breathing patterns to change. If and when she starts going into Cheyne-Stoking or Kussmaul respirations, the end is near. She won't be in any pain, but be sure to administer the morphine (and anything else) as ordered anyway, just to take away the exhaustion of air hunger.

The best thing is to love, talk to her and hold her hand, even if she slips into a comatose state.

Send me a private message if you require anything more.


Thanks for the advice. Really. I appreciate it. I'm getting tired now though. It is 5:00 in the morning and I have been up since 2:00 sitting with her. Mostly because I couldn't sleep. I'm going to ask about that "law" regarding the rails or restraints. I'm curious myself to find out what the story is with it. I'll let you know.

seeker_two

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #10 on: December 19, 2008, 05:52:04 AM »
myrockfight & Bogie: I'm praying for both of you and your families in this situation....
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Hutch

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #11 on: December 19, 2008, 10:13:31 AM »
Bogie, my heart goes out to you.  I buried my mother, father, brother and favorite aunt in a 26-month period, due to the effects of smoking.  I was with my mother at that moment, and it was literally years before a single day went by that I didn't recall that moment.

My wife is now a hospice nurse.  I really wish that had been a common service back in the early '90s when my family needed it.
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myrockfight

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #12 on: December 20, 2008, 12:09:17 AM »
Of the years I've spent in hospice care nursing, both private duty and facility, I want you know that I empathize with you and your family. I hope that your family will take full advantage of hospice care, that includes such services as counseling before and after your Grandmother's passing.

While I don't live in Florida, I suspect you are being misinformed. Generally speaking, It's unlawful to fashion restraints without a physician order, but not safety or positioning devices. Please contact your hospice case worker for a physician order for bedside rails if required. They are there to help.

Thanks Don't Care. I have been looking for information on the bed rails. I don't know if they were trying to cover their arses by saying that their was a law against it or not. But it is certainly looking that way. As I said before, she is delusional/hallucinating (I don't know the technical definitions, but you get the idea as per my previous post). She broke her neck a couple of weeks ago, supposedly from trying to get out of bed to walk somewhere.

What I'm having a hard time with, is that they knew she was delusional. And they knew she was becoming more mobile. She had been working with PT and was taking steps with a walker. So I don't understand why they would restrain her in some way to some degree so she would do exactly what she did. When my Dad told me that she was doing well with PT and almost getting to the point where she could walk, my next thought was that she was going to get up and try to walk at some point and fall and hurt herself. It wasn't two weeks later when she fell and broke her neck.

I'm not saying that their is any one person responsible, blah, blah, blah. It is just frustrating to me that more common sense measures weren't taken. We wouldn't be in this situation at this point. I don't know. Maybe I am not thinking straight about this stuff right now. I haven't been getting enough rest with everything.

She is still breathing pretty strong as of right now. Her O2 saturation is still ~94%. They drain her lungs when she gets really clogged up and have her on a med to help her breath more comfortably.



I just wanted to say thanks again for the thoughts, prayers, and advice. It is appreciated. Y'all aren't as bad of a bunch of guys as I thought you were!  =D JK. I hope everyone up north is bundled up pretty good. I hear y'all are getting some really cold weather here directly.

Bogie

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #13 on: December 20, 2008, 01:04:50 AM »
Just keep the meds going, and agree with everything she says.
 
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myrockfight

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #14 on: December 20, 2008, 01:32:50 AM »
Just keep the meds going, and agree with everything she says.
 


Well she isn't conscious any more. If she is. She doesn't respond. They think she recieved more brain damage due to the fall or at some point directly after. I would have a super hard time trying to let her go if she was still conscious. Thanks Bogie.

mgdavis

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #15 on: December 20, 2008, 01:54:15 AM »
My sympathies to you and your family.


Re: the bed rails-
In Washington State, it is not lawful to raise all four rails without a Doctor's order for restraint. The rails may be raised, then the order obtained after the fact however. The standard practice in my facility is to keep the upper rails raised with most patients, and raise the secondary ones when necessary.

I was going to add more about restraints and falls, but I think I'll leave it at: It's often not as clear cut as we wish, and falls do occasionally happen despite the best of intentions.

MillCreek

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #16 on: December 20, 2008, 04:10:42 AM »
My thoughts go out to you.  I would only add that on the issue of rails up and restraints, in addition to any applicable state laws or regulations, there are strict JCAHO accreditation requirements on this subject.  Rails and restraints are now applied far less frequently than in the past.
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ilbob

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #17 on: December 20, 2008, 10:57:46 AM »
Bad news. My grandmother is in hospice. She contracted pneumonia again after breaking her neck and her nose after falling out of bed. Apparantly, in Florida, there is a law against putting the rails up on the sides of beds?

Its generally not permitted in Illinois either. This has led to a weird situation where a substantial number of nursing home patients sleep on mattresses that are on the floor. It is really strange to go through a nursing home and see people sleeping on the floor.
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AJ Dual

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #18 on: December 20, 2008, 11:16:10 AM »
Yeah, the bed-rail thing is because less reputable care facilities would just put up all the rails and leave the elderly in their beds rather than deal with them being mobile. Bed-sores set in, rashes from soiling themselves etc. The doctor's order is to confirm there's a real need for it, like fall risk, dementia etc.

I hope they push the meds for your Grandmother. My paternal grandmother, extra special to me, because the one who cared for me for a few years while my father was at work, when my mother divorced him when I was two. She died last summer of a MRSA infection in her heart, and a failed pig-valve graft. Once the cardiology results came back, they gave her a Haldol and Fentanyl cocktail, and cranked up the infusion pump.  :O

She didn't feel a thing. Made it easier on all of us, knowing she was not laying there worried about dying.

Prayers for both of you.
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myrockfight

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #19 on: December 20, 2008, 11:05:47 PM »
Thanks AJ.

Well today was the day. She passed on at 14:13. I was relieved for her. It was peaceful and quiet. I'm glad for her.

She lived a very long, good life. She was born in 1918 of eight siblings in an all Italian family. She married my grandfather before he went off to war. My father was born before the war was over. My grandfather came back from fighting in Italy after being shot 3 times in the torso (one bullet grazing his heart). Lucky guy. Tough, huh!? Anyway, he got a job when he got back with Ford. They built a good life together and subsequently had my uncle who is mentally handicapped.

My grandmother has always had a big heart. She has always taken care of my uncle, up to last year (lacking 3 days) when she had her stroke. They had a co-dependent relationship (in a good way) where he drove her where she needed to go and she took care of everything else (she never got her driver's license). There are some pretty funny stories concerning that.  =D

The past few days have been largely trying to console my Uncle. He has the mentality equivalent to a 11 or 12 year old. They have lived together his whole life and she was his best friend of course. I can't imagine how hard this is for him and I feel really sorry for him. I'll be spending a lot more time with him and trying to fill that void while we can help him work out the permanent adjustment. You know, it might be a good idea to get him some counseling of some type from someone who is more familiar (clinically) with his mental state to help him work through this. We know how to communicate well with him and there is a certain way to get ideas across to him. It just takes a little longer. However, he can't handle anything to abstract.

In a way, the past year has been a blessing. Instead of my grandmother passing without warning and in short order - she was disabled with the stroke and moved to the nursing home after stabilizing. Then she came back with a little with therapy, but not all the way. But enough to get my Uncle used to the fact that things are/were changing. Over the past couple weeks, with her breaking her neck and then getting pneumonia, we have gradually helped him understand that her passing may be near. Of course, now we are here. I'm hoping the progression over the last year has helped. I think it has. We'll just have to work with him and see.

Geez. I feel like I keep asking you guys for stuff. Does anyone know of anyone who would be able to deal with the psychological issues of a mentally disabled individual? Don't Care? No pressure. Just wondering. I may talk to hospice about it. They may know which direction to point us in.

Thanks for all the kind words guys. It is nice to have the support. But if you are going to pray for someone. Pray for my Uncle. I'll be fine. I'm more worried about him. He's a 12 year-old kid trapped in a 61 year-old's body.

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #20 on: December 20, 2008, 11:32:14 PM »
It's a healthy sign that you're concerned about your uncle. I'd say it demonstrates that you've prepared yourself for your grandmother's passing.

Prayers for your uncle and grandmother (and you) on their way up.

Don't care

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« Reply #21 on: December 21, 2008, 12:01:37 AM »
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« Last Edit: February 19, 2009, 02:15:40 PM by Don't care »

Iain

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Re: Pneumonia, lack of food and fluids - How long to live?
« Reply #22 on: December 21, 2008, 05:46:36 AM »
Best of luck with the uncle, that's a very hard situation.
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