"Get Her Some IV Fluids"

Acknowledge him, be honest about your role, and get the nurse - do not argue and do not promise.

A workable response: "I'm glad you're here. I can't order IV fluids or start them - that's between you and her hospice team, and I'll call the nurse right now so you can talk with her. I want you to know what I'm seeing: she's very drowsy and her body is slowing down. What I can do is keep her comfortable, keep her mouth moist, and stay with her. Her team has talked about how fluids at this stage can make her breathing harder because of her heart."

Reasoning:

• Do not give clinical explanations you cannot back up with authority. It is appropriate to say the hospice team has discussed this; it is not appropriate to debate the son about fluid physiology on your own.
• Call the nurse now. This is a change in condition plus a family request for a treatment decision - it cannot wait for the nurse's return.
• Do not simply say no and walk away. The son's request is grief and love. Acknowledge it, then redirect to what you can do.
• Do not offer food or fluid to a drowsy, dying resident without nurse direction - risk of choking and aspiration, and it does not relieve the thirst he is imagining.

Afterward, document the son's request and that the nurse was notified.

Everything here is about comfort, not correction.

Breathing:

• Position for ease: head of bed elevated or side-lying, whichever she finds easiest. Reposition gently and often, supporting her head.
• Keep the room cool and aired, with a fan moving air near - not on - her face; stuffy air makes air hunger worse.
• Stay calm and quiet. Your own calm breathing and presence reduces her distress, and the son will take his cue from you.
• Do not assume oxygen is needed. Turning up oxygen or "fixing" the pattern is a nurse decision; the deep-shallow pattern with pauses in a dying hospice resident is expected.
• Report any signs of distress - grimacing, restlessness, pulling at the sheets, moaning - because untreated pain or air hunger needs a nurse and medication.

Dry mouth:

• Oral care is the most effective thing you can do: small swabs, moistened sponges, lip balm, and tiny ice chips if the nurse has approved them. Frequent small oral care beats a cup of water.
• Do not pour water into her mouth. She is drowsy and cannot protect her airway.

Reasoning: in hospice, thirst is relieved by moisture in the mouth, not by volume in the stomach, and your job is the mouth and the position.

Report the signs that indicate she is actively dying so the nurse and hospice team can support the family and adjust comfort medications.

Report:

• The breathing pattern (periods of deep and shallow with pauses) and when it began.
• Cool, mottled hands and feet, and any new mottling on knees or lips.
• Decreasing urine output.
• Drowsiness, minimal intake, and inability to take oral medications by mouth.
• Any sign of pain or distress.
• That the son requested IV fluids and food.

What to tell the son, in plain language and without a timeline: "Her body is shutting down slowly. Breathing that changes like this, cool hands, and not wanting food or drink are signs her body is letting go. She is not suffering from hunger the way we would. She can hear you - talk to her, hold her hand, keep her mouth moist. I'll stay with her and keep her comfortable."

Reasoning:

• Do not predict a time of death. "She has hours to days" may be true, but only the nurse or provider should say it, and it is often wrong.
• Do not say "she is starving" and do not say "she is fine." Both are false. Name what is happening gently.
• Do not remove or debate hope. Support the son's presence, and let the nurse handle the treatment conversation.

Document the signs you observed, the times, your comfort measures, and that the nurse and the son were informed.