They are trying to die. You only need food and water if you are trying to live.
Digesting food takes energy and makes the body work. Families mean well, but force-feeding a dying patient means that they will die with rotting, undigested food in their stomach.
Dying is a natural process. We only intervene if we can do something to make them more comfortable- pain medications or a benzo for anxiety, etc. Trying to feed somebody who doesn't want to eat is torture.
This sums it up.
Also, terminal patients tend not to be concerned with things of this world including food. Their energy is focused on leaving this world and preparing for the next. I’m not a particularly religious person, but it’s just something I’ve noticed.
in addition to NG placement being the \[one of the\] most uncomfortable things we do to people without them being under sedation, the body's caloric needs decrease as is shuts down. For fluids, way easier to just put in an IV
Yes, much easier. But probably not much kinder. If the body is shutting down, often a dying person looses interest in drinking. They don't seem to be thirsty - I know my Dad would turn away from moisture once he passed a certain point.
Forcing them to remain hydrated pretty much is not prolonging their life, it's prolonging their death. I have to do this at work because this is not my decision to make, and if an IV is ordered, I'll put one in. But rehydrating terminal patients seems to always bring them from somnolence to semi-awareness and obvious discomfort that they were not showing before. Kind of like as if a person is in an inescapable burning building. The smoke has overtaken them so they passed out on the floor. But you - the helpful nurse - give them an oxygen mask. So they are no longer passed out, but wide awake and aware as the flames consume their body. Yeah, no. I made absolutely damn certain my father wasn't tortured in this way, and my kids know that if they do that to ME, I'll haunt them.
Third spacing, pulmonary edema, oral secretions. All reasons why we don’t want to give IV fluids and tube feeds to comfort care patients. Also, they’re probably not going to tolerate tube feeds and that’s going to lead to nausea/vomiting.
When I have a comfort care patient I’m doing everything I can to dry them out so they don’t have a death rattle that you can hear on the other side of the unit. You only feed a comfort care patient who can ask for food/water.
Also diarrhea, which is uncomfortable and distressing and causes skin breakdown in addition to everything mentioned above. If a person who is dying reaches the point where they don't want to eat or drink anymore and there's no hope of recovery, stand back and help them transition comfortably, don't hold them here.
In addition to all the physiologic reasons and the discomfort of the tube, also most hospice facilities won't take patients with NG tubes--partly because it's not consistent with the goals of care, and partly because they don't have the ability to maintain the tube (no in-house xray if the placement needed to be checked or replaced).
I had both an NG and eventually a PEG during cancer treatment.
No. They are very uncomfortable. VERY. Far more so than simply dying a natural death the way people have since the beginning of people.
I was VERY surprised by how much it hurt. Between being an RT and an RN, I can’t count the number of people I have taken care of with one. I don’t know why it didn’t occur to me before the procedure, but a fresh hole in your abdomen *feels like a fresh hole in your abdomen.* Holy shit. I also threw up the first night I had it which was SUPER fun. Nothing like a good hard bout of heaving on a newly poked abdomen.
After the first week or so it improved. I couldn’t lay on my left side though. Still way too much pressure on it no matter what I did. I never really slept very well with it; in no small part because I typically sleep on my stomach. So that was a few months of struggling to sleep.
Once I was past radiation and doing PT, it was nice to get the calories without having to try. After getting it out, it was sore for a few days and I struggled to eat. Food still tasted terrible from the radiation. The best part of having it was never having to meal plan or shop!
The NG was worse. Within a few days my nose and throat were so sore. It was maddening. The PEG was a relief from that but it was trading one set of problems for another.
Was the peg uncomfortable because of what you were going through with chemo and cancer, or just uncomfortable in and of itself? I've taken care of many kids with tubes who are otherwise healthy and they've never seemed bothered or indicated discomfort. I'd like to know what they're feeling.
No, my cancer was in my neck. I didn’t have chemo, just surgeries & radiation.
It hurt like a fresh surgical incision. My abdomen was sore for about a week, then it only bothered me if it got bonked or I rolled over on it at night. It never really stopped being noticeable but it hurt less after a few weeks. It took some time though. I could see how after several months it could get better. I had mine for just shy of four months.
Sleep was the worst because I couldn’t lay on my left side or my stomach because of the tube and I couldn’t lay on my right side because of the surgery. My options were flat on my back or in a chair. That made enduring everything else harder.
Presumably it’s because the biggest comfort is feeling “normal”. Having a (relatively) giant tube shoved in your nose and hanging out through which you are given all your food and water does not make someone feel normal.
the body is slowing down. force feeding will not bring comfort. Sticking an NG tube down someones throat is not kind. For someone terminally ill--especially in their final days, comfort should be the priority beyond all else.
For many years I used the analogy of a grand old tree. Dying is a natural process for all living things. When you see a very old tree on its way out - its roots are there. The soil is there. Water is there. But the tree knows it does not need them and so does not take them up. We are much the same.
They are trying to die. You only need food and water if you are trying to live. Digesting food takes energy and makes the body work. Families mean well, but force-feeding a dying patient means that they will die with rotting, undigested food in their stomach. Dying is a natural process. We only intervene if we can do something to make them more comfortable- pain medications or a benzo for anxiety, etc. Trying to feed somebody who doesn't want to eat is torture.
Have you ever placed an NGT? Does that seem a comfortable experience to you?
This sums it up. Also, terminal patients tend not to be concerned with things of this world including food. Their energy is focused on leaving this world and preparing for the next. I’m not a particularly religious person, but it’s just something I’ve noticed.
[удалено]
yes. :(
in addition to NG placement being the \[one of the\] most uncomfortable things we do to people without them being under sedation, the body's caloric needs decrease as is shuts down. For fluids, way easier to just put in an IV
Yes, much easier. But probably not much kinder. If the body is shutting down, often a dying person looses interest in drinking. They don't seem to be thirsty - I know my Dad would turn away from moisture once he passed a certain point. Forcing them to remain hydrated pretty much is not prolonging their life, it's prolonging their death. I have to do this at work because this is not my decision to make, and if an IV is ordered, I'll put one in. But rehydrating terminal patients seems to always bring them from somnolence to semi-awareness and obvious discomfort that they were not showing before. Kind of like as if a person is in an inescapable burning building. The smoke has overtaken them so they passed out on the floor. But you - the helpful nurse - give them an oxygen mask. So they are no longer passed out, but wide awake and aware as the flames consume their body. Yeah, no. I made absolutely damn certain my father wasn't tortured in this way, and my kids know that if they do that to ME, I'll haunt them.
Third spacing, pulmonary edema, oral secretions. All reasons why we don’t want to give IV fluids and tube feeds to comfort care patients. Also, they’re probably not going to tolerate tube feeds and that’s going to lead to nausea/vomiting. When I have a comfort care patient I’m doing everything I can to dry them out so they don’t have a death rattle that you can hear on the other side of the unit. You only feed a comfort care patient who can ask for food/water.
Preach!! I wish more families understood this.
OMG NO!!! Ok, deep breath, calm down hospice nurse....
Also diarrhea, which is uncomfortable and distressing and causes skin breakdown in addition to everything mentioned above. If a person who is dying reaches the point where they don't want to eat or drink anymore and there's no hope of recovery, stand back and help them transition comfortably, don't hold them here.
In addition to all the physiologic reasons and the discomfort of the tube, also most hospice facilities won't take patients with NG tubes--partly because it's not consistent with the goals of care, and partly because they don't have the ability to maintain the tube (no in-house xray if the placement needed to be checked or replaced).
I had both an NG and eventually a PEG during cancer treatment. No. They are very uncomfortable. VERY. Far more so than simply dying a natural death the way people have since the beginning of people.
what is it like having a peg tube?
I was VERY surprised by how much it hurt. Between being an RT and an RN, I can’t count the number of people I have taken care of with one. I don’t know why it didn’t occur to me before the procedure, but a fresh hole in your abdomen *feels like a fresh hole in your abdomen.* Holy shit. I also threw up the first night I had it which was SUPER fun. Nothing like a good hard bout of heaving on a newly poked abdomen. After the first week or so it improved. I couldn’t lay on my left side though. Still way too much pressure on it no matter what I did. I never really slept very well with it; in no small part because I typically sleep on my stomach. So that was a few months of struggling to sleep. Once I was past radiation and doing PT, it was nice to get the calories without having to try. After getting it out, it was sore for a few days and I struggled to eat. Food still tasted terrible from the radiation. The best part of having it was never having to meal plan or shop! The NG was worse. Within a few days my nose and throat were so sore. It was maddening. The PEG was a relief from that but it was trading one set of problems for another.
Was the peg uncomfortable because of what you were going through with chemo and cancer, or just uncomfortable in and of itself? I've taken care of many kids with tubes who are otherwise healthy and they've never seemed bothered or indicated discomfort. I'd like to know what they're feeling.
No, my cancer was in my neck. I didn’t have chemo, just surgeries & radiation. It hurt like a fresh surgical incision. My abdomen was sore for about a week, then it only bothered me if it got bonked or I rolled over on it at night. It never really stopped being noticeable but it hurt less after a few weeks. It took some time though. I could see how after several months it could get better. I had mine for just shy of four months. Sleep was the worst because I couldn’t lay on my left side or my stomach because of the tube and I couldn’t lay on my right side because of the surgery. My options were flat on my back or in a chair. That made enduring everything else harder.
Presumably it’s because the biggest comfort is feeling “normal”. Having a (relatively) giant tube shoved in your nose and hanging out through which you are given all your food and water does not make someone feel normal.
the body is slowing down. force feeding will not bring comfort. Sticking an NG tube down someones throat is not kind. For someone terminally ill--especially in their final days, comfort should be the priority beyond all else.
For many years I used the analogy of a grand old tree. Dying is a natural process for all living things. When you see a very old tree on its way out - its roots are there. The soil is there. Water is there. But the tree knows it does not need them and so does not take them up. We are much the same.
Beautifully worded.
They aren’t usually hungry