Being a caregiver for an elderly parent is hard on so many levels. For your whole life they have been independent and an authority figure. Once the shift happens in that you are now the authority figure, it’s a very tough line to walk. Know that sometimes you have to be the tough guy and trust your instincts to seek the best care for her. She may not want to go to the ED, but remember that her dementia can affect her logic and decision making capabilities.
As far as her heart health, I would speak with her cardiologist on how to handle this situation in the future. Many times an extra dose of diuretic is all that’s needed to get out of the valley of fluid overload. I would ask for rules on when it would be okay to give an extra dose instead of go to the ED. What you really want to watch for and go to the ED for is any signs of difficulty breathing related to fluid overload. This would be shortness of breath or a wet sounding cough. Weight gain and decreased urination does not always necessitate an ED visit.
To impress upon her the importance of managing symptoms and following advice, I would explain that an ED visit early prevents a hospital stay later. It is far easier to intervene early with an assessment and dose of diuretic in the ED, than allow the symptoms to progress to the point of difficulty breathing requiring more advanced interventions and an admission to the hospital. It’s also critical to keep her fluid status balanced without overuse of diuretics in light of her kidney failure. So though an extra diuretic may get rid of the fluid, it could do more harm than good to her kidneys, so it’s best that a medical professional make the decision based on her labs and symptoms.
Be well, Tessa