Blue about Code Blue - page 4

by barbaralynn

7,589 Views | 42 Comments

I am a new nurse working on the Oncology floor. The stages of cancer we treat vary from newly diagnosed to metastatic. Some of my patients have good prognoses while others have only weeks or possibly days to live. Recently I... Read More


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    Maybe med school needs to spend more time on coping with end of life issues.

    The nursing model of healthcare seems to have a more realistic view of dying than the medical model does. Why do so many doctors seem to want to fight to the bitter end?

    It'd be interesting to see some MDs' opinions on this subject.
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    Once as I was participating in the care of a patient with an inoperable brain tumor who came to my ICU in Status Epileptics....I heard the oncologist repeat over and over that the 48 yo patient , who had a limited DNR (no defib no CPR), was seizing due to hypoxia and needed to be intubated. Proclaimed success when the chemically paralyzed patient stop visually seizing....and she informed the family that they had been stabilized.

    To me that MD needs to be taken aside and given the what for....to me that is giving false hope and is cruel and unusual punishment. No wonder they were hysterical and devastated when this patient died hours later when they herniated their brainstem.....while the oncologist was at home snug in their bed, leaving it up to the ICU nurses to help this family find some peace.
    *** Oh ya, been there, done that. A few times it was I could do to stop myself from yelling "THAT"S BS!" when listening to a physician (usually not an ICU doc) tell families something like that. I WILL give families my educated opinion on the likely outcome for their family member. Occasionaly this leads to them confronting the physician and that makes him angry with me. Oh well that's why I get paid the big bucks.

    I know there are worse things than death. I have seen them and cared for them.
    *** Right? We should put that on a T shirt.

    I think using terminology like "using a machine" to "help them breathe".....are using euphemisms for the real thing. How many times have heard a family flip out when they found out their loved one is on "life support" because no one told them!!! so you tell them what did they think the tube was...they state..the doctor told me it was "a temporary tube to help them breathe"....that their loved one "never wanted to be on life support".
    *** I too have heard that "what do you mean he is on life support!?" The term "life support" doesn't mean anything to us. It's like a medical TV show term that we don't use but families often use it.

    I
    Esme12 and BrandonLPN like this.
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    Quote from anotherone
    Will there come a time here where payment dictates what is done?
    *** Wouldn't that be great!? Can't come soon enough as far as I am concerned.
    LibraSunCNM likes this.
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    If the pt is alert, oriented, and want a full code, that's what they should get. Even if their choices are hopeless.
    The scenarios that truly bother me, are the ones involving pts who are basically already gone. They no longer even remember who they are, but the family demands "everything be done". They don't want to make the hard decisions, so they just don't. I've often wondered if the choices would be the same if the family had to pay. Even a portion.
    PMFB-RN likes this.
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    Quote from imintrouble
    If the pt is alert, oriented, and want a full code, that's what they should get.
    Which is fine, as long as they've had the proper education about their choice.
    PMFB-RN likes this.
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    I'm a nurse but I always think about my grandfather when it comes to this exact situation. He was admitted with acute renal failure and upon admission they found stage 4 lymphoma. He had a long history of health problems with multiple surgeries. When I went to visit him in the hospital I asked his nurses about his code status and was surprised to find that he was full code. When I asked my family member (POA) about why he was a full code, she didn't didn't even know what a code was! After I explained what they would and could do, she was horrified. After speaking about the status with other family members and his longtime doctor, it was changed. A lot of times we have patients who are still full code because only an attending can change code status and it simply doesn't happen.
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    Quote from meggiepie24
    I'm a nurse but I always think about my grandfather when it comes to this exact situation. He was admitted with acute renal failure and upon admission they found stage 4 lymphoma. He had a long history of health problems with multiple surgeries. When I went to visit him in the hospital I asked his nurses about his code status and was surprised to find that he was full code. When I asked my family member (POA) about why he was a full code, she didn't didn't even know what a code was! After I explained what they would and could do, she was horrified. After speaking about the status with other family members and his longtime doctor, it was changed. A lot of times we have patients who are still full code because only an attending can change code status and it simply doesn't happen.
    I don't know your family situation obviously, but I presumed that your grandfather wished to have his code status changed.

    In the case of my family, I have older family members who have experienced acute renal failure, with multiple other serious medical problems including cancer, who with their medical problems managed well are enjoying their lives and would be horrified to not be made a full code.
    Last edit by Susie2310 on May 7, '13
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    Quote from imintrouble
    If the pt is alert, oriented, and want a full code, that's what they should get. Even if their choices are hopeless.
    The scenarios that truly bother me, are the ones involving pts who are basically already gone. They no longer even remember who they are, but the family demands "everything be done". They don't want to make the hard decisions, so they just don't. I've often wondered if the choices would be the same if the family had to pay. Even a portion.
    An elderly patient who is acutely ill may not be alert and oriented when they are hospitalized. This does not mean that their baseline level of functioning in their life is not good. They may have many medical problems and still be enjoying their life, wish to live, and find life worthwhile. As nurses we do not have the right to decide at what point a patient's choices are hopeless. That decision is for the patient and their family/POA; it is not the nurse's decision, even if you completely disagree with the decision made. So while these situations may bother you emotionally, you are not God, and you are only charged with caring for the patient and carrying out the patient/family member's wishes.

    In regard to your question as to whether the choices would be the same if the family had to pay even a portion, often the family are paying at least a portion, and really it is none of our business as nurses.
    Last edit by Susie2310 on May 7, '13
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    Educating the families and pts about a DNR and what it means is not playing GOD, if anything it is allowing nature to take it's place.. By default pts come in as a full code many times because no one has asked. I have had more accounts when the pt declines and the family asks what can be done, once the options are explained the family state " No, mom/dad etc would not want that"..

    So many things wrong its really hard to pin point. Partly because of TV showing a code as a peaceful event and the person almost always comes back. The other issue is MD's in all areas of medicine not talking to families about the reality of what they are facing. Just because we can do something doesn't mean we should. And lastly families refusal to let go. Death is a natural part of life, although painful, we will have to say goodbye. I personally wish it was peaceful.
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    Quote from maybelaterRN
    I'm a fairly new nurse (just a few weeks shy of a year), working in oncology as well. The situations you've described are the hardest part of being an oncology nurse for me. Unfortunately, the providers I work with do not have end-of-life discussions with patients and their families until the patient is days or sometimes hours away from passing. I've watched multiple patients struggle and be miserable simply because they don't have adequate education about the severity of their disease process and the likelihood that treatment won't be successful. I wish DNR, palliative care and hospice discussions started at diagnosis, and that people understood that DNR does NOT mean "do not treat." While talking about end-of-life care isn't the most pleasant thing for many people, it would enable patients to make educated decisions regarding code status, hospice, treatment options, etc.
    I disagree that palliative care should be discussed at diagnosis unless they are stage 4 with limited treatment options or none. Most patient want to fight early on. However I think the discussion should come up before they are terminal.


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