Full Code Hospice Pt Acute Change in Condition...What to Do?

  1. 0 Last night I had a hospice resident who also happens to be a full code. This individual presented with an acute and significant change in condition. Primary Dx mets cancer. He presented with sudden decreased LOC, unable to follow simple commands, one sided facial drooping and could not grasp at all with that same side. Also unable to swallow. Acutally, seemed unaware that there was anything to swallow when a cup was placed on his lips. He was staring off into space and would occasionally offer one-syllable responses when prompted after several attempts. VS's were stable in otherwise no acute distress. I sent him out after speaking with his hospice nurse citing the code status. I was unable to reach family for their input. He looked mighty CVA-ish to me. However, with the mets and not being a MD with all the fancy equipment I can not rule out a brain mets that caused the acute change. Either way, I did not feel comfortable with the situation at all and erred on the side of caution and obtained the order to send out. What would you have done or have done under similar circumstances?
  2. Visit  bluegeegoo2 profile page

    About bluegeegoo2, LVN

    bluegeegoo2 has '7' year(s) of experience and specializes in 'LTC'. From 'Austin, TX area'; 43 Years Old; Joined Feb '07; Posts: 594; Likes: 952.

    34 Comments so far...

  3. Visit  MichelleRN34 profile page
    4
    Quote from bluegeegoo2
    Last night I had a hospice resident who also happens to be a full code. This individual presented with an acute and significant change in condition. Primary Dx mets cancer. He presented with sudden decreased LOC, unable to follow simple commands, one sided facial drooping and could not grasp at all with that same side. Also unable to swallow. Acutally, seemed unaware that there was anything to swallow when a cup was placed on his lips. He was staring off into space and would occasionally offer one-syllable responses when prompted after several attempts. VS's were stable in otherwise no acute distress. I sent him out after speaking with his hospice nurse citing the code status. I was unable to reach family for their input. He looked mighty CVA-ish to me. However, with the mets and not being a MD with all the fancy equipment I can not rule out a brain mets that caused the acute change. Either way, I did not feel comfortable with the situation at all and erred on the side of caution and obtained the order to send out. What would you have done or have done under similar circumstances?
    Why is the patient a full code on hospice...regardless sending the patient out was the best option.
    ktwlpn, loriangel14, texasmum, and 1 other like this.
  4. Visit  bluegeegoo2 profile page
    0
    He admitted to us as a full code on hospice a couple of weeks ago. I've no idea why that remains his status.
  5. Visit  MunoRN profile page
    1
    There are some situations where a patient is seen by Hospice for the purpose of symptom management where the patient does not have an imminently terminal condition and being full code might be appropriate. But in the situation you describe being a full code would be inappropriate, if this patient were sent to my hospital they would not be offered the option of being a full code; BLS and ACLS have no established potential for any beneficial effect in patients who suffer cardiopulmonary arrest in the setting of metastasized cancer. While not an optimal situation, sending him out was still your best option.
    bluegeegoo2 likes this.
  6. Visit  pretty70 profile page
    1
    I did not know that a Hospice Patient can be full code. I would do the same you did.
    loriangel14 likes this.
  7. Visit  sallyrnrrt profile page
    1
    unfortunatly, some time families are resistant, hospice should handle it, your social worker could help, it is times like this i have that heart felt talk with family, related to some of the treatment options are doing more harm, or not helping, as related to code status, sometimes i even describe resitation.......i really do not remember the last time, family did not decide that to maintain full code....

    you did right in sending him out....i would have sent him out great assessment
    bluegeegoo2 likes this.
  8. Visit  SuesquatchRN profile page
    1
    You have to ship. And yes, one can be on hospice and remain a full code.
    nrsang97 likes this.
  9. Visit  CapeCodMermaid profile page
    4
    Quote from MunoRN
    There are some situations where a patient is seen by Hospice for the purpose of symptom management where the patient does not have an imminently terminal condition and being full code might be appropriate. But in the situation you describe being a full code would be inappropriate, if this patient were sent to my hospital they would not be offered the option of being a full code; BLS and ACLS have no established potential for any beneficial effect in patients who suffer cardiopulmonary arrest in the setting of metastasized cancer. While not an optimal situation, sending him out was still your best option.
    They would not be offered the option of being a full code???? Let me know where you work so I NEVER go there. People are entitled to make their own decisions even if they are what you think are the wrong ones.
    sallyrnrrt, SuesquatchRN, nrsang97, and 1 other like this.
  10. Visit  subee profile page
    0
    Wow. I'm didn't even know that a hospice had the nuts and bolts to run a full code. You have patients on vasoactive drips?
  11. Visit  bluegeegoo2 profile page
    0
    Quote from subee
    Wow. I'm didn't even know that a hospice had the nuts and bolts to run a full code. You have patients on vasoactive drips?
    I work in a LTC facility. This gentleman was admitted to hospice in the community. As his condition deteriorated it was decided that he needed more care so the family admitted him to my facility. His hospice team comes to see him here.
  12. Visit  lauriepat profile page
    2
    I ran into a similar situation- had a dying pt on hospice and no dnr on file. I contacted my DON and she took care of it..he didn't die on my shift but technically cpr wasn't performed and we never had a signed dnr, but the facility i work at is incredibly screwed up.
    I would call hospice or my DON and be like uhhh we have a problem.
    The last thing i want to do is CPR on someone fragile and on hospice!!
    MedChica and bluegeegoo2 like this.
  13. Visit  HappyWife77 profile page
    0
    My first assignment with hospice....the pt was in cheyne stokes after three hours of my arrival at their home. When they were going.... their daughter changed her mind and we had to call 911 and the fire dept did cpr on a very fragile pt. Usually if they are within a terminal diagnosis of less than three months to live we will not accept them as a hospice patient and a full code status. Family can change their mind anytime they wish. You did a great job by sending them out.
  14. Visit  chrisrn24 profile page
    1
    DNR doesn't mean do not treat. You did the right thing.
    ktwlpn likes this.


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