DNR's - page 2

I am wondering about LTC facility's, are most of the patients DNR? As a nurse how often do you have to do CPR on patients? I would expect most of them are DNR. I am considering getting a job in LTC... Read More

  1. by   slinkeecat
    I too have ran a code on the elderly and have cracked ribs and it is beyond icky. I felt terrible for days afterward. I just cringe thinking about it
  2. by   caffine addict
    I have been working in LTC for about 10 yrs and have been in a few different facilities. Each facility has a different culture with regard to DNRs and different residents with different values as well. For example I worked in a non-profit, religious affiliated facility where the population was mainly female over the age of 70. In that facility the majority was DNR and/or hospice. I now work in a facility which is mostly male residents 35-70 and the majority are Full Code. Yet in another facility that was predominantly another race believed in doing EVERYTHING to keep their loved ones alive. In all places our crash carts were a joke as well. I agree to ship them out as fast as you can. Another problem i've faced was trying to explain to the families of the residents who were DNR but send to the hosp. for tx for Pneu. for example, was that once they get into the ambluance there are different rules and the person may get coded on the way if something happens.
  3. by   Hacamila
    Originally posted by mjlrn97
    I had to do compressions once on an 89 YO lady who probably weighed 80# and had such severe osteoporosis that she had fractured her hip just by trying to get up from her wheelchair. ORIF was done on the insistence of the family, who were in the hallway arguing with her PCP about her full code status just as I was calling the code. Her post-op vitals had been heading downhill ever since she'd been brought to the floor, and suddenly she dropped her pressure to nothing. Having never done CPR on a real person, I was unprepared for the sickening sensation that travels all the way up your arms when you fracture ribs, and I almost freaked out. (I still get chills just thinking about that first time.) Thank God the doc FINALLY talked some sense into those people---that, and the fact that they all heard that first "crunch" made them realize hey, maybe we're not doing Granny any favors here---and we were permitted to stop the code when she flatlined.

    Again, as I stated on another thread, I feel this is cruel and unusual punishment, and I can't imagine why anyone would put a fragile, sick elderly relative through it. I know a male nurse who has DNR tattooed directly over his heart, and several of my friends at work (along with myself) are DNRs as well, even though we're all still (comparatively) young and healthy. If the only other option is suffering interminably, I'd rather not, thank you!
    After reading your post, I feel better about the DNR decision I made for my elderly mother. She passed away ,in the hospital, 3 weeks ago, and I have struggled with guilt about the DNR decision I made. I'm not a nurse but I work in the medical field. When the attending nurse told me my mother was gone (died in my arms) my first instinct was to do CPR on her. I started to, then my gut told me to let her go. Now, I'm second guessing myself because I miss her so. I hope I did the right thing.
  4. by   Reabock
    Hacamilla, You did the right thing, don't ever feel guilty for letting a natural end to life come to a loved one without the violence and trauma of being coded if you know in your heart that it is the way
    the loved one would have wanted it. Last spring, my dad stated he did not want to go back to the hospital for another GI bleed, 3 days later he passed away quietly at his home, as he wished. Neither my mother or I have felt anything other than that we did as he wished.
  5. by   Hacamila
    Originally posted by Reabock
    Hacamilla, You did the right thing, don't ever feel guilty for letting a natural end to life come to a loved one without the violence and trauma of being coded if you know in your heart that it is the way
    the loved one would have wanted it. Last spring, my dad stated he did not want to go back to the hospital for another GI bleed, 3 days later he passed away quietly at his home, as he wished. Neither my mother or I have felt anything other than that we did as he wished.

    You have helped ease my pain. Thank you from my heart!:kiss
  6. by   graysonret
    You did okay, Hacamila. My mother died too, quietly and with dignity. I think many family members tend to be in denial over a loved one's placement in a LTC facility, hence the code. Listing 80 year old frail cancer patients as a FC seems to me, a crime. Yet, I see it many times. I wonder if many people really know what is involved with CPR? Probably their information comes from tv shows where, after a few minutes, the patient is fine, talking and stable! lol. I've done CPR..both as a medic and a nurse. The best one can hope for, is to stablize them...cracked ribs and all. In reality it's exhausting, frustrating, and, in most cases, usually fruitless (in LTC).
  7. by   bigred
    At the LTD I work at, most of the residents are DNR or "comfort care". About 1/4-1/3 of the residents are "full intervention". Personally, I feel sorry for the resident who is full intervention, because when all is said and done, many of these people are pretty well "done". I have worked there many years, and only once did I do CPR on a resident. We were not sure if her sudden demise was natural or accidental. Under the circumstances I initiated CPR. When the Dr arrived a couple of minutes later, he told me I could stop. Later on he told me that I did the right thing under the circumstances. As it turned out, she died of natural causes, thank the Lord. In those days we did not have "Care Directives". Good luck to you should you decide to work in LTC.
  8. by   maelstrom143
    Quote from Reabock
    Hacamilla, [...] Last spring, my dad stated he did not want to go back to the hospital for another GI bleed, 3 days later he passed away quietly at his home, as he wished. Neither my mother or I have felt anything other than that we did as he wished.
    I am a fairly new nurse. However, I am all for DNRs and usually feel bad for those of my residents who are not, when we know they will only suffer when coded. However, I have come across an ethical dilemma and you may be able to help me with it.
    We have an active GI bleed at our facility. He is a DNR. He was taken to the hospital and given a transfusion. Yet, the rectal bleeding has not stopped. He is actively bleeding out, but nothing is being done save give him anxiety meds and pain meds. Does DNR mean let them bleed to death? What is my role in this situation, as a patient advocate? Is it right to stand by as we are doing or should something be done to stop the bleeding? Any input would be greatly appreciated. I have agonized over this for quite a while. I have found intervening has helped a few of my patients and want to do what is best for this wonderful elderly gentleman. Any input, even if it is only to increase his comfort/quality of life, would be greatly appreciated and ease my burdened soul. As it is, I cannot help but wonder if I am doing all I can for my patient. Thanks in advance.
    Last edit by maelstrom143 on Jan 14, '07
  9. by   nursejohio
    A resident at the nursing home I worked in had a HUGE gi bleed. I'd pull his pants down for toileting, and clots would drop on my shoes He wasn't in any pain, just tired all the time. His son was POA, and discussed with dad what he wanted done. They tried one transfusion with RBCs and platelets, but it didn't make much difference. He lasted a couple weeks after the bleeding started.

    His (and thank heavens his son agreed) opinion was that he was 86, had lived a good life and wasn't suffering. If he decided to go with more painful and aggressive measures (colonoscopy, surgery etc) the outcome probably wouldn't change by much and he'd most likely spend the rest of his life in pain. The docs didn't think that much bleeding could come from just a small polyp, and were as certain as they could be (without invasive testing) that it was cancer. So, he had the choice to stay in the nursing home with caretakers who knew and cared about him, taking meds for any pain he might have later OR be aggressive, have major abdominal surgery and most likely pass away in the hospital among strangers shortly after the bowel resection, if he even survived the operation.... Not much to think about really
  10. by   maelstrom143
    Thank you for your input. We have had clots, as well. It is so hard, because our patient has dementia and keeps yelling "Help! Help!" and yet is unable to tell us how we can help him when asked. It leaves one feeling as if one has not done as much as one could. I could not help but cry once my shift was ended and I could leave the floor. I am very fortunate to love my job and those I work with, but sometimes cannot help but wonder if I am doing all I can. I hope in time to be as sure as some of my coworkers.
  11. by   Calgon-take.me.away
    After working in health care as an EMT and and LPN, have had to do CPR numerous times. You never forget the feeling of going straight thru ribs when doing CPR on a 98# lady with osteo. gives me chills just thinking about it. I also want DNR tatooed on my chest and will haunt whomever does not follow my wishes. If the families who insist on CPR could only witness the trauma and cruelty they are instilling on their loved ones by wanting CPR, I am sure more would sign the all important DNR orders. But, as an EMT,,,,,,unless you provide me with hard core proof that grandma is a DNR, I gonna pump and blow. Better yet, if at home grandma is gettting bad and you want nothing down,,,,,wait till she has gone to her heavenly reward before calling.
  12. by   shoreh2000
    i agree with nj lnha. that is an excellent practice.

    the resident must have a preferred intensity of care when admitted, which includes cpr, tube feeding, iv's, antibiotics, transfer to the acute care hospital, gastrostomy/nasogastric tube feeding, etc.

    as an ex-surveyor i don't really think there is any regulation per say but it is something you review with the idt (including the social worker), family/resident on a quarterly basis, change of condition and prn.
  13. by   jetscreamer101
    Quote from Just Angi
    When I reach that point in life- I think I will have DNR tatooed on my forehead. That way no one will misunderstand. So many times by the time people reach LTC the family is making that decision. I suggest that if you don't come to see your relative but once or twice a year, don't make them suffer with making them full code. I wish everyone was required to have a living will at the age of 18. That way, whether it is old age, a wreck, or anything else that will alter the mind the person will have the wishes they have for themselves carried out.


    Don't take this wrong. Hopefully with the tattoo of DNR others will know your wishes. Just remember DNR doesn't exclusivly mean do not recuscitate. It'd be my luck to collapse in a national forrest and the person that finds me thinks I'm an employee (dept. of natural resourses).

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