My grandma is 81, she has dementia, diabetes and 4 stents in her heart. No allergies.On Friday the 12th, she fell in the mall near our home after a visit to a cafe. She was taken to the hospital and testing there revealed her kidneys have failed and potentially her heart, it's now the 16th and I want to know what questions I can ask the doctors to find out what's going on, she has been given unspecified fluid and no other treatment we're aware of What questions can I ask to find out what's going on, what can I do to make it easier for her and why would her medical team do nothing all weekend? We're in Ireland
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There might not be a lot more that they can do.
She's very old, with a lot of complicating conditions. Especially considering she has dementia, your family should be discussing what they want the end of her life to look like: full of pain and fear in the hospital as they continue to poke and prod and do chest compressions that will break her ribs, or to allow her to die naturally, with medication for comfort, wherever she is most comfortable, surrounded by those that love her.
I'm very aware of that fact, and we've had those discussions! I'm very worried as we have a DNR and DNI on file but these doctors keep taking her at face value (yesterday she told them she lived alone and they were shocked when I corrected them) How do I get the doctors to tell me the truth then? My mom doesn't want to take her home unless there's nothing left as her own kidneys (my mom) failed and she knows how awful it is (she's fine now, it was an allergic reaction!) Yesterday on the phone it felt like a bunch of non answers and drip feeding information.
Just jumping on to add that if her kidneys are failing and her heart is failing, it's very tricky to manage treatment.
She needs IV fluids to help her kidneys excrete waste products but if she is in heart failure, her heart cannot pump efficiently. This means that this extra fluid will sit around her lungs and make it hard to breathe. So, they may need to stop the fluids. Which hurts her kidneys...so, she gets fluids. Which hurts her heart...
It's a vicious cycle unfortunately :( really sorry about your grandma.
I think this may be what they're looking into, on the advice of another comment I got onto patient laison services and found out they've taken her off most of her meds and are setting up an echocardiogram
They also said she was dehydrated when admitted but she drinks enough tea to fill the Boston Harbor herself
Tea can be a diuretic as well :/
ETA: they'll stop all medications that can harm her kidneys so this isn't out of the ordinary
I'm sorry I don't understand what that means
Sorry, I meant to put it in layman's terms. It makes you pee more frequently and if she is not also hydrating with plenty of water, she may be significantly losing the hydration factor from the tea
Diuretic is something that makes you pee
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Some of these interventions require care in a high dependency unit care or intensive care unit. Not something that can be done on a ward. Also, it may be that she is too unwell to tolerate these medications.
They can check blood gases (which will also give you pH, lactate etc) but having values and no way to fix them isn't exactly helpful. And arterial stabs are not pleasant at best, and excruciating at worst.
ETA: Look into cardio renal syndrome. It's really a horrible cycle.
Yes correct but that’s how you treat HF in intensive care. I don’t know if she’s in a ward or a high dependency unit and the OP didn’t state it either. I guess they need to find the underlying root cause but she’s too sick to do any proper investigation. That’s why I wrote there’s nothing much that can be done.
Yep, you're correct. Wasn't disagreeing with you.
Based on the treatment, I assumed she wasn't in HDU or ITU. If she has a DNR in place (which OP mentioned I think), even more likely that she's on a ward.
No problem. Makes sense.
You have to consider quality of life here though. Dying from dementia is a lot worse (a slow) than dying from an acute kidney failure and heart failure. Just because something is possible to be done doesn’t mean it should. There is an ethical line in the sand so to speak
Absolutely. 80s and dementia? I would want treatment for absolutely nothing beyond comfort care. There are fates worse than death and that’s a good long life.
It sounds like your family needs to request a meeting with her providers to discuss what the plans are.
I doubt they would offer dialysis, it's a completely different situation than what your mom dealt with, so it will also feel different because they will be treated differently.
Thank you for the advice, a meeting is not possible as the hospital is on complete lockdown with norovirus. Everything is over the phone
A meeting over the phone (or zoom) can be done. It's not as nice as an in person, but we do that all the time for families who can't get here or something
I wasn't able to get in contact with her medical team but I did get the patient liason manager. Thank you
Have they mentioned AKI? Acute Kidney Injury?
This can be quite common in the elderly and can be caused by a multitude of things. Some AKIs resolve just by giving IV fluids, stopping medications that are contributing to the AKI/nephrotoxic (damaging to kidneys).
With the added heart issue it makes management more complex and youve said she has had an echo to help them find out what's going on.
She will also be having daily bloods
It doesn't sound like they 'arent doing anything'. They are doing what they should be doing.
Chronic kidney malfunction was the term used. Sorry I can be a bit jaded. 2 weeks ago they kicked her out of the ER