Dad with UTI

mpang123

Yesterday, my mom called me and told me dad got nauseous and threw up shortly after breakfast. He fell and couldn't get off the floor. My mom called hospice and they called 911 to just pick him off the floor and onto his bed. When I came over, my dad was on the floor again next to his bed. He tried to get out of bed to his wheelchair but didn't make it. I lifted him up and put him back to bed. Then my mom showed me his urine sample and it was bloody red! I called hospice nurse to see what's wrong with dad. When the nurse came, she confirmed it was bloody and said that when he fell, he pulled on his catheter and traumatized him causing him to bleed. When the nurse changed his catheter, he bled profusely and thought he needed to go to the ER. But I found out that if he goes to the hospital, he will be discharged from hospice and would have to be readmitted to hospice when he comes back home. Fortunately, his bleeding subsided and was put on antibiotics after confirming he had a UTI that caused everything including a fever. He complied with taking the antibiotics, not sure if he was going to resist taking it due to his previous rejection to taking other meds. Today, he's much better. No more blood in the urine, he is coherent and good appetite and strong enough to be able to be on his feet. Since he seems to be recovering well, I came back home today and am always on standby for the next thing to happen. I know my parents appreciate my help and that's the least I can offer them.

fmb

@mpang123 Unfortunately UTIs are quite common with indwelling catheters. My DH has had several. While his hospice will not culture a urine sample, they do provide antibiotics as comfort care. Bleeding from catheter trauma is a big concern, too, as DH has BPH and a prostate tumor. Inserting a new catheter is like threading a needle with a very small eye. Is your DH on a blood thinner? You and hospice may want to consider discontinuing it if he is.

You may want to clarify with your hospice provider the circumstances that require removal from hospice. My DH's provider told me that he would have to come off hospice only if he were admitted to the hospital. An emergency room visit would not disqualify him. At his advanced stage (stage 7), DH will not be going to the ER for anything.

mpang123

Fmb, my dad is not on blood thinners, thank goodness otherwise he would probably bleed to death! But my dad is very anemic and has an enlarged prostate making inserting a catheter difficult. He is taking Cipro for UTI. He has an out of hospital DNR. If he got admitted, I would request full DNR. Luckily, he recovered well without going to the hospital so hospice is still continuing.

easy23

I agree with @fmb; my mother was on hospice and she could go to the ER without being removed from hospice. It was only when she was admitted that she was discharged from hospice. Getting back on hospice was no big deal.

fmb

https://alzconnected.org/discussion/comment/219685#Comment_219685

@mpang123

Good to hear that he is recovering well. DH has been on Cipro a few times. Like any other antibiotic, it has to be used judiciously to prevent antibiotic resistance.

It can take time to get a DNR form processed in an emergency room setting, so this is something you would want to do before it may be needed. His doctor or hospice provider should have blank forms on hand. POLST is the most common form, but it may be called something else in your state. In Pennsylvania (my state), it requires the signature of one physician, physician assistant (PA) or certified registered nurse practitioner (CRNP). It also requires the signature of the patient or surrogate. If you have medical POA, you can sign the document on the patient's behalf. It specifies exactly the treatment the patient is to receive or not receive, including DNR. If the patient lives at home, it is suggested that it be kept in a prominent place in plain sight (like the front of the refrigerator, for example). There is also a wallet card available. As POA, I signed one for DH as soon as his doctor declared that he was unable to make decisions for himself. It is on file at his ALF, with a copy provided to hospice.

The following link provides more information:

https://polst.org/programs-in-your-state/