Changing code status to DNR/DNI

  1. 4 There is something just so satisfying about locating your 95 year old demented patient's advanced directive in the computer and having the hospitalist change his code status to DNR/DNI...
    Last edit by Lev <3 on Oct 14, '13
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  3. Visit  Lev <3 profile page

    About Lev <3, BSN, RN

    Lev <3 has '2' year(s) of experience and specializes in 'Med-Surg, ED'. From 'Another planet'; Joined Jun '11; Posts: 1,302; Likes: 1,893.

    14 Comments so far...

  4. Visit  kp1987 profile page
    0
    Why is that satisfying?
  5. Visit  BrandonLPN profile page
    32
    Quote from kp1987
    Why is that satisfying?
    Because no one enjoys shattering the ribcage of the dead body of a 95 year old.
  6. Visit  SaoirseRN profile page
    4
    Quote from BrandonLPN
    Because no one enjoys shattering the ribcage of the dead body of a 95 year old.
    Exactly.
    loriangel14, BriRN, SoldierNurse22, and 1 other like this.
  7. Visit  jrwest profile page
    0
    Assuming the 95 y/o still wants it? which i hope if they still have a mind , can say so.

    I must say I feel relief usually also if pt has advance directives/molst forms.

    Have had a few aox3 >85 y/o lately.

    ooops , didnt see "demented" pt - sorry
  8. Visit  Altra profile page
    9
    Quote from kp1987
    Why is that satisfying?
    It reduces the chances that there will be a messy end to what hopefully has been 95 years of fruitful life lived.
    loriangel14, Do-over, BriRN, and 6 others like this.
  9. Visit  Lev <3 profile page
    3
    Quote from kp1987
    Why is that satisfying?
    For one thing, you are carrying out his wishes as stated in his living will. Also, if in case he did code, we wouldn't have to crack open his fragile ribs to give him maybe a couple more months or weeks to live (which he did not want to begin with).
  10. Visit  Lev <3 profile page
    2
    Quote from jrwest
    Assuming the 95 y/o still wants it? which i hope if they still have a mind , can say so.

    I must say I feel relief usually also if pt has advance directives/molst forms.

    Have had a few aox3 >85 y/o lately.

    ooops , didnt see "demented" pt - sorry
    His living will said he did not want any measures to extend his life. He was demented. Wife was signed over as POA.
    jrwest and SoldierNurse22 like this.
  11. Visit  yesnoyes profile page
    3
    I agree. I personally wouldn't say I feel satisfied, specifically, but I definitely do feel relieved and less anxious while caring for them.
    Daliadreamer, twinkletoes53, and Lev <3 like this.
  12. Visit  AlphaPig profile page
    0
    We get patients from local nursing homes all of the time who are admitted as full codes. . .they are usually about 100 yrs old, dementia, FTT and admitted for either AMS or a fall. . .and when going thru their admission paperwork I find DNR forms! I HATE it. I call the doctors and get them to change the order in the computer but what if something happens during those couple of hours it takes a doctor to do anything? Would I have to jump on their chest??
  13. Visit  upurkilt profile page
    3
    I applaud nurses advocating for their patients when they are unable to communicate for themselves. It appears from this post that this patient took the time to prepare in advance by putting a legal advance directive together. These documents are legally binding and unfortunately go unnoticed way too often. If a patient chooses to have no cpr and to be kept comfortable then we must abide by this wish. I am a palliative care nurse and ask the all too difficult questions every day, however, when I ask a 96 y.o what their goals are for their care while they are in the hospital it usually comes in the form of "Oh honey, I told the doctor I didn't want to come back here to the hospital. I've had a good life. I just want to be back home with my friends and be comfortable. No one lives forever." POLST forms are used to transfer these wishes into a ACTIONABLE physician order. We may think we are protecting the patient from an uncomfortable topic, and don't wish to cause them distress in facing their own mortality. But believe me you are going to cause them WAY more discomfort, brutality and distress when THE GORRILLA enters the room to perform CPR. So please advocate, investigate and follow thru with patients wishes whether spoken to you or written in a legal document. This is what makes nursing the wonderful profession that it is.
    Lev <3, Altra, and jrwest like this.
  14. Visit  ktwlpn profile page
    2
    Quote from Lev, BS, RN
    There is something just so satisfying about locating your 95 year old demented patient's advanced directive in the computer and having the hospitalist change his code status to DNR/DNI...
    It's much more satisfying being one of the team of nurses who have been educating the family member about the reality of their loved ones condition. I'm in LTC on a dementia unit and have spent HOURS with family members providing education and emotional support .After all of the education and counseling I still have to accept that sometimes people just don't "get it". I no longer see that as a failing grade and I don't personalize it. I seem to have the knack of turning one little phrase that often breaks through the denial-it usually brings on some tears but then allows the family to move forward. It's an honor to work with these families and support them and their loved ones through the end of their lives.
    Lev <3 and Altra like this.
  15. Visit  Lev <3 profile page
    0
    Quote from AlphaPig
    We get patients from local nursing homes all of the time who are admitted as full codes. . .they are usually about 100 yrs old, dementia, FTT and admitted for either AMS or a fall. . .and when going thru their admission paperwork I find DNR forms! I HATE it. I call the doctors and get them to change the order in the computer but what if something happens during those couple of hours it takes a doctor to do anything? Would I have to jump on their chest??
    I think "slow code" would be the ethical way to go..or get someone to change the order STAT.


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