DNR? Why not? - page 3
i've worked ltc for my entire nursing career and i love my little ole men and women literally to death! what i want to know is that when they reach this point in their lives where they need us to... Read More
Sep 27, '02Originally posted by night owl
I.rae, I scratch my head intensly as I'm sending them to you!? I understand that it's the family's decision alot of the times, but my hat goes off to those who come to their senses at the very last minute when the Doc calls the family explaining prognosis is poor, condition is grave and there's not much more we can do. Making a decision to keep trying to revive them is futile.
Sep 27, '02Hey guys
I just wanted to say that you may have your opinions about DNR and think you know what is best, but it is exactly that, one's own opinion. My mother to this day insists to keep her on full support as long as she can be and to never, ever take her off. Now whether or not I agree with this is besides the point, to her she is right.
Sep 27, '02Reference Uncle Jimmy... There are many similiar situations. My brother has control over my mother's assets since he won a conservatorship over her a few yrs ago when she had a temporary, yes I said temporary, medical problem and needed hosp. My mother has since recovered and feels like a prisioner in the board and care her son stashed her in. He sold her house and took everything. She wants to live with her brother but can not do a thing. My other brother and I are at a loss. I want nothing to do with the situation b/c I would probably kill that man if I ever got my hands on him. I believe there should be a special place you know where for children who put their parents away to get their assets. The sad thing, this brother was to get it anyway. He just doesn't want to be bothered with mom.
Sep 27, '02Originally posted by canoehead
Personally I would share successful/unsuccessful code statistics with the 80-90 year olds if I could find them. Does anyone know a web site with this information?
"...published studies indicated that nursing home residents receiving CPR had a survival rate ranging from 0% to 2%."
What I would like to find is actual statistis with reference to who did the study and when and where it was reported. If I find anything I'll post it here.
Sep 27, '02Here's one reference:
CPR and age
This prospective cohort study looked at outcomes by age group alone and found that the global success rate of CPR in over 2,000 community dwelling adults of all ages was 7.25% (survival to hospital discharge). Interestingly, in the 70-79 age group 7.1% survived and 80 years and older 3.3% survived. The authors suggest that "Out of hospital" resuscitation of elders is not associated with a "universal dismal outcome".
Swor, RA et.al (2000). Does Advanced Age Matter in Outcomes after Out-of-hospital Cardiac Arrest in Community-dwelling Adults? Academic Emergency Medicine Volume 7, Number 7 762-768.
Sep 28, '02Thank you, I will print that one off. You would think somewhere they would have success rates of in hospital codes divided by age.
I'll post if I find any.
Sep 28, '02We've got the same kind of law as Don wrote about: no other adult can give permission for a DNR.
We ask patients when they are admitted, whether they have a patient-will and that is what doctors and nurses hold on to.
By patients with Alzheimer or something, there is always a legal (not a family-member) advocate to contact.
Basically nobody is on DNR.
Oct 7, '02Caliotter3 -
I think if I were in your situation regarding your brother being your mother's POA when the original reason was for a TEMPORARY medical condition that I would contact the Division of Aging in your state. Usually, a POA states that the power it gives is only assumed in the event that the patient is unable to take care of their own business/health matters i.e. IF your mother has been declared incompetent.
It seems to me that this is actually a form of abuse on your brother's part and may even have criminal implications misusing her assets and funds- especially the part about selling her home. He can only use her money for her and not allocate it for his personal use. Everything about your Mom's situation with your brother screams illegal to me. I'm not a lawyer but I really don't think he can legally do what he is doing. Your Mom's physician should be a good source to also advocate for her rights. He should certainly know whether your Mom is incompetent and unable to take care of her own affairs.
Although in a few situations when I have had to contact them, they haven't been as helpful as I would have liked (way different situatoin)- I strongly suggest you contact your state's Long Term Care Ombudsman program which exists to protect the patient's rights. Someone can correct me if I'm wrong, but I don't think your Mom can be held against her will in the facility she's currently residing. Restoration of the funds your brother basically embezzled from her should be one of the first orders of business for you and your other brother. Your Mom needs you to advocate for her in this situation.
I am one of my Mom's Powers of Attorney and I don't believe I have a right to spend even one dime of her money on anyone except her. Besides, she has NOT been declared incompetent so my POA is only in effect in situations where she is unable to consent for herself - sedation, anesthesia etc. In ALL other circumstances my Mother consents for herself signing with an "X" if needed and witnessed by two persons. Please make these calls to the Division of Aging's Elder Abuse hotline and to the Long Term Care Ombudsman office for your state. Your Mom needs your help to live her life in an acceptable way and to NOT be a prisoner. Her rights have definitely been violated big time but you and your brother can do something about making her remaining years more meaningful.
Warm personal regards,
Oct 7, '02Has anyone ever had this problem? The reason I ask is that we have with our Mom's situation several times.
When she was admitted to the nursing home she and my sister and I were asked to fill out a form with respect to our resuscitation wishes. My Mom has chosen the #2 DNR option which basically means do not resuscitate her if you find her in an arrest situation BUT if she becomes ill treat ALL conditions vigorously.
Here's what our experience has been. She had symptoms of an MI and when the LTC nurse finally called the doctor and 911 about 7-8 hrs later, when they arrived they asked her code status. They were told she was a DNR. They interpreted this to mean transport her to the hospital in a non emergent fashion- no "lights and sirens, bells and whistles". No nitroglycerin given in the ambulance for continuing chest pain. She was examined in the ER and admitted to a medical floor instead of telemetry or the ICU in spite of elevated troponin levels which we were NOT informed of. NO nitro drip was started either in spite of the fact that the chest pain was unrelenting. Nitro paste was applied but that was all except a KVO IV. The doctor explained that because of her DNR status he would admit her to the medical floor and not thinking it through and never dreaming that in his mind it meant treating her symptoms as minimally as possible, I agreed. The next morning I got a call stating that her early morning troponin level was elevated and she was being immediately transferred to the ICU. THEN, I started really analyzing all that had transpired in less than 24 hrs and it dawned on me that they all equated DNR with" Do not treat"!
We have had to make this abundantly clear that ALL situations are to be treated aggressively and that her intentions and ours about DNR are simply as I stated- do not resuscitate if found to be in cardiac arrest. I wonder how many patients have expired because the DNR was interpreted the same way as it was with my Mom? I wonder how many patients have died because the EMS also interpreted this order with no TREATING the patient with nitro, etc. The EMT/Paramedic was the Captain in charge of the municipality's EMT/Paramedic program AND I might add, their INSTRUCTOR!!!
Every time the nursing home calls when something is wrong with my Mom they still ask if we want them to call the doctor and get orders to treat whatever is wrong or do we want her to be sent to the hospital!What the hell is the problem ?
Do we have a failure to communicate or does DNR also mean " do not treat"?
My Mom went on to have 3 cardiac catheterizations - 4 stents and 3 balloons and spent threee weeks in the hospital- a little more than 2 weeks in the ICU from the MI that went untreated for so many hours.
The Unit manager of the ICU was also the unit manager of the ER so when I approached her about these problems she was able to correct the situation in both places. She was really appalled and surprised about the breakdown in communication.She had the unit educator schedule an immediate mandatory inservice and invited me to attend if I wanted to. She also provided me with the written materials given to the ER and the ICU staff. The medical director also met with me to discuss the steps he has taken to prevent this from happening again. They didn't try to cover it up and I really appreciate that they didn't insult my intelligence. I completely appreciated their honesty. As a matter of fact, it was what prevented me from seeking litigation with an attorney over the whole mess.
Have any of you ever encountered this situation where the interpretation wa so distorted?
Warm personal regards,
Oct 8, '02Yes, Pappy,
I work in LTC and we sent a 91 yo DNR to the hospital with n/v , abd pain and acute anxiety. The called and asked us why she was there, including her pcp and the ER MD. We stated we don't diagnose and she needed treatment, they sent her back that night -diagnosis uti. She did however die peacefully in her sleep about a month later, unrelated. She was alert and grateful to us for taking such good care of her.
Yesterday I sent a 96 yo female who has refused to eat, refused tmt, is acutely depressed, just doesn't want to do this anymore, out to the hospital low grade temp, sl increased respers, hr 104, non diaphoretic, no apparent distress except slight lethargy but pulse ox of only 85% on 3L (she normally used no O2) . She took off the O2, refused it for EMT. She was a full code. Her dughter told me to tell her to shape up or ship out- and that her sisters lived to be 97! I don't know how she is now.
Pappy- I can see how communication could break down, but we just have to stop for a second to think about it! DNR does not mean do not treat!
This discussion has been very valuable to me. I have read articles about manipulating the outcome. I think a doctor does it when they state that the resident will "starve to death without a feeding tube."
Where do we draw the line between educating the families and manipulating the outcome? I tried to discuss the possiblility with the daughter yesterday of coming to a point in time to make the resident a DNR, she didn't want to - her right, but it is my job to start the process of education, what if it never ever entered her mind? Or am I trying to manipulate the outcome?
Blessings,Last edit by cargal on Oct 8, '02
Oct 10, '02I feel the same way you do. I don't think anyone in their right mind would like to live longer if they need an NG. I sure wouldnt. I admit I do have a tough time with death even if death is the best thing that could happen to them, and at the time I feel like I want them to come back, but that is really an unmerciful thought for me to have. They are suffering, SUFFERING people!!! If they came back they would suffer LONGER. I think that it is cruel to keep patients alive who are suffering and will not get any better.
Oct 17, '02Has anyone ever been in a successful code of a pt over 75??? We don't make the choices. I work in a LTC currrently, have worked on geriatrics in a hospital. Ran codes of 90 yr old pts and it is not a pretty sight. Ribs break, etc. Now if I have some one going "bad", I call the MD first, then the family. Usually, MD says "Well, if the sponsor wants them treated, send them." I do explain to the sponsor about comfort measures, codes etc. Like I said, we don't make the choices. What really stirs my grits is when someone is admitted for terminal care, has a signed DNR that spec. states no tubes or tx. to prolong my life, the DON insists on inserting an NG tube because: "We can't let them starve" Personally thinking of having D.N.R tattooed on my chest.