Question for nurses

[Lackinghope]

If you are a nurse, especially if you work in a care home do you know what a volvulus is without googling?

Im a retired nurse and I know what it is but it’s mainly seen in babies and infants not adults . We had a ragdoll kitten who suffered with a volvulus , had a bowel resection and 2 days later had another volvulus further along the bowel so ended up with another resection .

No , no food . We're losing our mum , it's heartbreaking to see her in so much pain and discomfort. We just want to make sure she's being looked after as best as possible .

I’m so sorry @Lackinghope .

FWIW I wouldn’t have known but would find out if anyone in my care had a diagnosis of anything that I wasn’t familiar (or confident) with.
I don’t work in that setting but I don’t think it matters.

Do you have access to the discharge letter ? If your Mum is considered to be nearing the end of life, she should have been discharged with medications to make her more comfortable which can be administered by community staff from the District Nursing team, do you know if this has been done ?
If that has been done then the care home should be able to contact someone from the District nursing team to help.
If it hasn't been done, then can the care home contact the out of hours GP's to get her reviewed and medication prescribed, so that she is comfortable ?
So sorry you are going through this

I don’t work in a care home but I’m a DN and yes I know what a volvulus is

Sorry @Lackinghope I forgot to check if your Mum is in a nursing home or a residential home.

Not a nurse but work in a hospital in a non-surgical area...I would know what one is after one of my patients was diagnosed with one after suddenly deteriorating and then being scanned, not long after coming to us.

Unfortunately they were too poorly and frail for surgery to fix it and they were palliated and passed away shortly after diagnosis peacefully, thanks to end of life medications helping to keep them comfortable.

I'm sorry to hear you're going through such a difficult time with your mum being so unwell, OP.

I am a palliative care nurse in a hospital, and have discharged patients home with a volvulus before, when it cannot be resolved.

Your mum should have come back to the care home with some end of life care medicines, and guidance for the care home and yourselves.
Our guidance for eating and drinking in this situation is usually to do whatever your mum wants. Some people will eat and drink, knowing they will likely vomit it back up later because they want to have the comfort of eating. Others choose not to eat and drink, others may choose to taste food, but then spit it out as they do not like being sick. The main goal is to keep your mum as comfortable as possible during this time, managing any symptoms as they arise.

So sorry you are going through this.

Thank you. That's the guidance we are looking for. As usual, it's the lack of communication that causes so much confusion and upset. I'm meeting with the palliative care team tomorrow, one of the carers mentioned anticipatory medication , mum is being given tablet morphine twice a day but she's still in so much pain and struggles to swallow the tablets.

Ideally your mum should have had a syringe driver in place to manage any medications. Morphine is too important to be giving orally. Hopefully the palliative care team will sort this out for her tomorrow.
If your mum seems in any pain, or unsettled, let the care home staff know. They should have injectable medications that can be given to help.

Yes of course

If she has anticipatory medications at the home, then she could have the medications as injections for the time being until reviewed by the palliative care team tomorrow, if she is in a nursing home then staff there should be able to give the medication as it is prescribed.
If she is in a residential setting then District nursing team should be able to come and do it. Not sure where you are in the country, but here, there are nurses 24hrs a day who can come and give an injection of medication to help your Mum be more comfortable.

I don't think the anticipatory meds have been prescribed. Mum tells us she is in pain and we can see it etched on her face , but she has declined the injections,I think it's because she thinks she'll have to go to hospital to have them .

It would normally be on the discharge paperwork if they have been sent home with her from the hospital, with instructions on doses etc. If she is in pain I would be pushing the staff to contact the out of hours GP and the District nursing team, especially if they are unable or not confident giving the medication themselves.

This is really not ok. If your mum came out of hospital and they felt she was at the end of her life, it is standard procedure to send home the medications.
I would check with the care home staff. If they do not have the medications I would get them to contact the out of hours GP. It sounds like your mum really needs those medications now.

Can you reassure her that the nurses can come to her and that she doesn't need to go back to the hospital if that is what she wishes ?

the injections are done in the stomach, dh had them at home when he was dying. If she’s refusing them the nurses hands are tied even without capacity you can’t hold people down to administer drugs and needs can break off if the patient moves too much it’s a safety feauture.

Also anticipatory meds aren’t held at every pharmacy, our gp dispensary had them and I had to show my ID to get them.

We have told her that she won't be going back to hospital. She's very confused. She was speaking in full sentences a few days ago. Today she was just rambling in a sort whisper. I'm not sure she's taking in anything we say .

I know it's an impossible question to answer but how long can she go on like this? We can't bear to see her like this.

Sadly it sounds as though your mum is reaching the end of her life so all management should be aimed at making her feel as comfortable as possible. If she wants to eat little bits and can enjoy that I wouldn't stop her doing that. Medications for pain / nausea etc are probably better given subcutaneously as if she still has a volvulus it's likely she won't absorb them. Transdermal patches for analgesia could be another option but take a bit longer to kick in. I would try to speak to GP / palliative care team / district nurses, this is very much their bread and butter. Hoping she gets to being comfortable and so sorry you're in this situation.

It sounds very upsetting, if she was sent to the home for end of life care either the hospital or GP should have prescribed anticipatory medication, the carehome staff shouldn't leave her in pain so they need to contact the out of hours GP service. There's no need to wait to see the palliative team tomorrow.

If you get the care home to ring the out of hours doctors and the district nurses they can come and talk to your Mum, assess the situation fully and gain consent from your Mum to give her something to make her more comfortable.

Is she in a nursing home or a residential home? That does make a difference

If she’s struggling with tablets there’s alternative options such as patches or liquid medication - this should be considered before jumping to injectable medications

its a nursing home, she was having liquid oxycodone but the nurse asked for it to be switched to tablet morphine because said oxycodone burns the throat, which I'd never heard of before.

They would still need a doctors prescription and many care homes are prescribed for named patient only. Not like in hospital. If she is having trouble absorbing then liquids may not help and the patches are slow release, she might also need anti sickness and a sedative.