Comfort measures only ???

txspadequeenRN, BSN, RN · Jul 20, 2006

I means your measures should comfort the patient and not make attempts to treat and cure . In my facility we would have d/c'd all lab, blood sugar monitoring, IV's and anything that causes discomfort or irritation to the patient. The patient is allowed to die in comfort. This usually means hospice and comfort meds if needed....

Hoozdo, ADN · Jul 20, 2006

In my unit it means no O2, a fentanyl drip, an ativan drip if needed. No labs, no monitors, no accuchecks. Family is allowed to visit liberally and a pt is put in a private room.

kwagner_51 · Jul 20, 2006

OK so its different everywhere. If its just comfort measures then why does he ave IV ATB and IM pain shots Q2H?

One other question:

If a pt has MRSA, do you get that info in report? I ask because this pt was diagnosed with MRSA on June 28. I found out about it on July 19th!! The CNA's had no clue and one of them stated they were never informed of pt health because it violated Hippa.

Any advice?

Also on the original question, his output was about 100 cc's and that was before the Lasix. On my 8 hr shift, he had 700cc's infused and sounded wheezy with rhonci throughout all fields.

Thanks!!

__________________________

In His grace,

Karen

Failure is NOT an option!!

KellieNurse06 · Jul 20, 2006

Geez it drives me absolutely insane when their are no exact clear stipulations and when people think DNR means do absolutely nothing at all......I did clinicals in one hospital wherethere was a patient dying...not at that exact moment but was in the process ( they died like 3 weeks later)...they stopped all tube feedings, and just had a morphine drip going.....it was very sad to see but the patient wanted to be left alone..the patient would even say loudly & very irritated " no more"..........anyway what really got under my skin, but I am only a student and this patient wasn't mine, but was right next to the patient I had in the next room.......the patient needed suctioning and one nurse on staff refused.....and another wanted to suction the patient for comfort.............well the nurse who wanted to phoned the patients family & got their ok because family consent over rides doctor on treatment on most things............I personally think if the person is comfort measures only then isn't suctioning making them comfortable????? Gee lets let the patient drown in their own secretions! :angryfire

I have a DNR on my daughter which everytime she goes into the hospital I have to have written & signed exactly what is to be done/not done.........I have no chest compressions but she can get chemical intervention because I figure if her heart isn't going to keep going if drugs don't help...certainly chest compressions are not going to do diddly.......and I also have the vent as ok if she has trouble breathing only because she sleeps on one at night anyway at home so it's not like she would suddenly be thrown on one ....we put her on it at home if she has repiratroy difficulty from a cold or stuff like that as well anyway............and she can have pain meds too................so thats pretty much it....before I was a wreck over this & trust me I came very close a few times where she almost passed but pulled through on her own......so I think if she's meant to go (as for everyone else as well) that when it's your time, it's your time.....it's nature but anything that can make it as comfortable as possible is a good thing...who wants to die in pain or drowning etc......

pkeyrn · Jul 20, 2006

I work in long term care. We often have residents at the end of life who have what we call "Comfort Care Orders". However, the MD must sit with the resident,family and Nurse Manager or Social Worker and go through a long checklist.They can pick and choose exactly which orders they wish to have...such as no tube feedings, no invasive tests/procedures, no hospitalization or emergency room visits, no antibiotics, discontinuation of medications, provision for analgesic meds if needed, etc. The point is that it is always a discussion and a cumulative effort to get these orders in place and everything is documented carefully so that all staff know the specific and exact orders in place for each resident on Comfort Care.

Hoozdo, ADN · Jul 20, 2006

One other question:
If a pt has MRSA, do you get that info in report? I ask because this pt was diagnosed with MRSA on June 28. I found out about it on July 19th!! The CNA's had no clue and one of them stated they were never informed of pt health because it violated Hippa.
Any advice?
Also on the original question, his output was about 100 cc's and that was before the Lasix. On my 8 hr shift, he had 700cc's infused and sounded wheezy with rhonci throughout all fields.

Well if the pt has MRSA why isn't he in isolation? Where is his MRSA? Can it be spread by droplets........if so then he should go in isolation. Yes, IMO the CNAs should know.

For your second question - the pt is drowning. Do some pt advocation and get the IV fluids cut back to KVO. Look at the total picture.

leslie :-D · Jul 20, 2006

ivf should be contraindicated when the body is actively shutting down.

it is NOT a comfort measure; not for the pt anyway.

leslie