What would you do? or what should you do?

[Lammy01]

What are you supposed to do at YOUR hospital. Im not sure if it's different on every ward or what the case. But, what would you do in this situation.

Come on to shift patient ob's stable, medications given as charted, patient responsive and talkative. confused- but, nothing out of the normal for her. I come back 30 minutes later to help her with dinner. non-responsive. pupils pinpoint, no reflexes, elevated BP- but, that's not out of the ordinary for her either.

So I called a MERT or code blue- whatever your hospital calls it. Doctor comes down. says that it may be because she hasn't had her Madopar yet- uhhh. not sure itd do that. but, he says to give it to her. i refused. he said crush it and put in jelly. i said she is non responsive. he said well just hold her medications and don't do anything for the time being.

anyways. is it hospital policy for YOU to call a code when a patient is unresponsive or can you just call the doctor? or what do you do in your hospital? if the patient is DNR do you still call a code?

Im required to call a code. but, you still get yelled at by the senior nurses for doing it. tonight i kept going back and forth with an old nurse saying im not willing to risk my license. it really isn't worth the risk and i said id do the same thing over again if i had to.

just curious what other peoples situations are like....

I work in a small private hospital and during the evenings there are no doctors on the floor- really after 3pm and if you need anything you have to call their mobiles and get phone orders. and there is a charge nurse but, it's not a manager and well i dont always have that much trust in them.

[evolvingrn, BSN, RN]

If the pt is a DNR what would be the purpose of calling a code?

[GreyGull]

Our Rapid Response Team is sent to an unstable DNR patient. If they have no signs of life, then, no.

A code team can be initiated when the need for resuscitation is a possibility. If the patient is still breathing and has a pulse but unresponsive, then the Rapid Response team may be all that is required and they'll determine the next step.

[OttawaRPN]

At my large, inner-city, tertiary-care teaching hospital, our code team is called RACE - call a code and they flock in droves to the bedside - hence the teaching opportunity.

At my small rural hospital we call a code and the ER doc comes up, along with RT and a few nurses. We are the code team.

No codes for DNRs.

[nminodob]

You say that she is unresponsive, pupils pinpoint, absent reflexes, and that's not unusual for this patient? You also say earlier she was talkative and the chart shows earlier meds were given - so s it standard procedure for this patient to be able to take PO meds sometimes, and then other times be unresponsive? I'm a little confused...is the nurse supposed to gauge her LOC each time the meds are given, and withhold them if she is unresponsive? Sounds like a dangerous situation to me.

[nurseraphael]

in our hospital a the criteria for calling a "RRT" Rapid Response team includes "ineffective communication" this can be called by the nurse or the family, or any member of the staff that feels that a patient is de-compensating and not getting appropriate care. I will always call the attending first, but i have called for a rapid response when I don't get the response that is needed from the MD. I find that our hospital encourages nurses to exercise their autonomy especially when a patients condition changes - even if their assessment was blinded by a bit of anxiety. Better to be wrong and have a live patient than to have been intimidated and have dead one!

[silentRN]

I don't call Codes on DNR pt's. May just want to update the MD on the pt's new status. I work in a big hospital where there's always an MD on the floor in the ICU I work for, so I guess that kinda spoils me because I can just peek around the corner and there they are. But ya, in the future don't call a code on someone who is a DNR.

[GreyGull]

I would say don't work a patient who is a DNR that has no signs of life. However, a patient shouldn't die from something that is easily reversible either such as a little too much medication or fluid. Sometimes people do sit on these patients a little too long before they call the doctor or a RRT/MERT/CAT because of the DNR.

[TakeOne]

...Come on to shift patient ob's stable, medications given as charted, patient responsive and talkative. confused- but, nothing out of the normal for her. I come back 30 minutes later to help her with dinner. non-responsive. pupils pinpoint, no reflexes, elevated BP- but, that's not out of the ordinary for her either...

This part is very confusing. Such a dramatic deterioration in condition, but not out of the ordinary for this patient. How can that be?

[nohika]

This part is very confusing. Such a dramatic deterioration in condition, but not out of the ordinary for this patient. How can that be?

I /think/ the OP meant that the elevated BP was the ordinary thing for the pt? I'm not sure, but that's how I interpreted it.

[scoochy]

DNR=DNR=DNR=DO NOT RESUSCITATE. I would be very upset if, after making the decision to have an advanced directive such as DNR in place, a nurse took it upon her/himself to override the DNR order.

[Lammy01]

when i said not out of the ordinary i was just meaning the BP, sorry that I wrote it funny.

And our hospital policy is that we STILL call a code if a patient is DNR and they go down the tubes like this. They didn't do CPR or anything like that. But, they can still do other things like certain medications and scans to figure out what is wrong. Right?

If I had a doctor on the floor I wouldn't call a code but, when there is no doctor it makes it a lot harder.