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5 Things You Need to Know
When Your Loved One is in ICU

By Susan Montminy, MSN, RN and Meredith Dodge, MSN, RN

(Page 2 of 4)  

Know your loved oneís wishes

Knowing your loved oneís wishes about quality of life and resuscitation is important all the time, but this information is vital when they are in the intensive care unit.  When a patient is unstable and there is no knowledge about their wishes, all heroic measures are done. Heroic measures include putting a breathing tube in the mouth, performing chest compressions and giving the patient an electrical shock when necessary  This is true even if there is no hope of survival.  If you know their wishes, let the healthcare team know early on.  It may save sorrow and heartbreak later on.

 Some patients linger in ICU.  They become weak and lack the ability to breathe without the ventilator.  Some also lack the ability to swallow.  The healthcare team may ask for permission to place a tracheostomy and/or a feeding tube.  At this time, you should ask the team these questions:

  •  What will be their quality of life?

  • Is the tracheostomy and/or feeding tube permanent?

  • What is the plan after these procedures?  Is the plan to try to wean and remove the ventilator or to assist for placement in a convalescent home?

  • Will my loved one be in a convalescent home until end of life?

  • What is the likelihood of a full recovery? 

When you hear these answers, give permission based on what your loved oneís wishes are.  Unfortunately the stress of the situation will sometime overwhelm families, causing them to make decisions based on guilt or their own beliefs.  Take time to really think, would he/she want to be on a ventilator or in a convalescent home the rest of his/her life?  Remember, it is never too early to have a living will, durable power of attorney, or a discussion regarding your wishes regarding quality of life.  A durable power of attorney designates someone that the patient has chosen to make decisions for them when they are no longer able to make decisions for themselves. Do this sooner than later! Also, once you have had these discussions with your loved one, be sure to stand up for your loved oneís requests and make them known to the health care team.

Multi-disciplinary family meetings

It is important to get frequent updates on how your loved one is progressing while in the intensive care unit.  As discussed earlier, communication between you and the healthcare team is vital.  However, families often complain about receiving mixed messages from different healthcare team members.  This occurs frequently when consulting physicians are asked by the family how the patient is doing.  They have the tendency of reporting on how their specialized organ or system is doing, not how the whole patient is.  For example, if you ask a cardiologist how the patient who has had abdominal surgery is doing, he will probably respond to only how the heart is progressing.  This is not out of malice or any intention of misleading you.  It is because many times they are only looking at their specific piece of the puzzle.

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