Specialties Geriatric
Published Feb 15, 2005
Hello All, Do u know where I can find information referring to Long term care scope of practice for RN's? What is the policy on starting cpr after rigor mortis set in? Thank you:)
CoffeeRTC, BSN, RN
3,734 Posts
In LTC most residents are checked at least every 2 hrs...some may go longer because they request not to be checked/ bothered or are more independant.
DON....I totaly respect and understand the DNR status...but what happens if someone wants cpr started...will your nurses until EMS arrives?
deegale
33 Posts
just curious does anyone know the success rate of cpr on the elderly? I've never known anyone in their 80's or 90's to live after having cpr
donmomofnine
356 Posts
:behindpc: good question!
And yes, we send them out when they start "going bad". No one really "wants CPR started" because they know we don't provide that. Most have great advanced directives and we are now working on getting advanced care planning. Advanced directives in our state are only for terminal conditions (although if you ask me, all my residents are "terminal"). Advanced care planning is a more elaborate discussion involving all sorts of "what if" scenarios and how family or resident would want them to be handled.
Do y'all use AEDs? Those are what really save lives, more than CPR, according to what I read.
rbrown74
1 Post
We have to obtain an order to stop cpr if someone is a full code and they are noted without vital signs--no matter if rigor mortis is set in or not. This is a protective documentation to prevent lawsuits and survey issues from the board of health.
Antikigirl, ASN, RN
2,595 Posts
I agree with the CYA bit! BUT, we have had this happen to me on occasion where the patient was obviously dead beyond chance of revival. At that point I did a very good assessment, documented what I saw, smelled, heard, felt..the whole bit before choosing not to perform CPR, including a very long search for pulses and respirations (part of CPR ).
Luckily for me, I have tried very hard to get all my patients POLSTS in order so we know what to do! So far I have only had to work with people with DNR's in place..whew!
I can't dx someone as dead...not my scope, but I can dx a severely terminal failure to thrive..LOL!
IF worse came to worse, I would take the assessment time while waiting for Paramedics to arrive...by the time they get to us (which is usually within minutes), I will have completed a good assessment and let the EKG prove it .
TracyB,RN, RN
646 Posts
At a facility I worked at, we had a "presumed death" policy.. Must be 2 nurses, one MUST be an RN... some of the criteria... pupils fixed & dilated, absence of BP, P, R, mottling.. I can't think of anymore, but there were several. I'll look around & see if I can find it.
I also wondered about the time frame & how often these residents were checked.
The facility Presumed Death Policy states that:
I. CPR will not be performed after an
unwitnessed cardiac arrest if the following is
present:
A. Pupils fixed and dilated
B. Mottled discoloration of the body
C. Absence of reflexes
D. Bowel and bladder sphincter control gone
E. Absence of vital signs (pulse and blood
pressure) with the presence of the other
symptoms listed above.
II. Before a decision to not resuscitate is made,
A through E must be verified by two licensed
nurses, one of which shall be a Registered Nurse
.
III. The findings shall be documented in the
nursing notes, along with the signature of both
licensed nurses. The Attending Physician will be
notified.
SmilingBluEyes
20,964 Posts
AFTER rigor has set in????? Am I reading this right???
bobnurse
449 Posts
unfortunately you are..........
CapeCodMermaid, RN
6,090 Posts
I wanted to use AED's in my facility...was told by the ED that it opens us up for lots of liability...suppose, he said, someone was having chest pains and they drove here instead of calling 911 because they knew we had an AED....yikes...suppose Chicken Little was right! I'd love to have them. We have quite a few patients who are full codes...in their early 60's and in for short term rehab. I've been there for 5 years and have only once had to use the ambu bag...we are VERY good at recognizing declining health and do not hesitate to call rescue.
"we are VERY good at recognizing declining health and do not hesitate to call rescue"
We are too! :)
ernurseok
7 Posts
When rigor has set in, they are DEAD!!!!!!!!!!!!!!