OK...here's the story....the patient has end stage Alzheimers disease and has lost the ability to safely swallow. The speech therapist has recommended she be NPO because the risk of aspiration is so high. The family agrees and doesn't want us to feed her and they DON'T want a GTube or IV fluids. The woman is on hospice services in my facility.
I have no problem with end of life...the woman has no quality of life at all, but is is legal to have an order to withhold food and fluids?? Wouldn't it be better to write an order "diet as tolerated"? Any legal eagles out there?
Dec 18, '04
"The pt is a dnr, the family does not want any invasive means of feeding or hydration, that is their rite."
Here we go again...oh man I am the worse lecture gal on this!!!!!!
OKAY...DNR is ONLY followed if a patient is NOT breathing or has NO pulse..then and only then is that followed! That has NOTHING to do with feeding or hydration before being pulseless and apnec! A DNR is not Do Nothing Regardless....
Why we get that one wrong all the time is beyond me! It only deals with death..do not bring back..not the journey there! A doctor...a Doctor under their license can determine an NPO by his clinical choice and his license..so we obey that...only then can we withhold what is considered reasonable humaine treatment...
A DNR doesn't EVER mean..stop..let them die...actually it is considered neglect and in some courts murder...tread carefully there...I have seen WAY too many lawsuits win for NOT doing something rather than honoring the DNR correctly!
DNR only involves death...that is it period. If you disagree...then I emplore you to look deeper into your state/provence laws.
Oh and yes..the family..it is NOT within their right to choose for a patient UNLESS they are a SPOUSE or POA! AND the only way they can resend a DNR is to say yes to treatment...but never NO! The reason behind that is simple..a family member or spouce may have THEIR best interests in mind...therefore their word on NO treatment holds no validity..but saying "do CPR NOW!" does...that is a win win...well according to law and liablity....makes sense if you think about it logically....
I had a daughter of a patient who...well he abused her thoughout life..sexually and physically...but he was very fiancially rich! She wouldn't do ANYTHING that wasn't covered by medicare...and he went into acute CHF..she screamed at me not to treat..he was breathing and had a pulse, jsut had some SOB and PAO2 of 70! I had her escorted out, got him to a hospital..and he was fine...thank goodness...he has many years in front of him..this was just a probelm increased by a flu! The daughter was investigated and they recented the POA! Sad for her...he hurt her thoughout life, but not fair to illicit murder with my license on the line! I was found beyond right...and accomidated by the EMS system in my state for my role in helping hold the correct meaning of the POLST (Oregon's state's DNR order or :Physicians Order for Life Sustaining Treatment..which is an ACTUAL MD order! WHEW!)....It was CYA for us nurses..and it worked!
Be very careful throwing the old DNR phrase around...9 times out of 10 I find the one throwing has no idea of the ramifications or rules behind it...and not by their ingnorance...but by the fact is it not taught!!!!!!!! It is the grey..but has disipline that is very black and white!
Last edit by Antikigirl on Dec 18, '04
Last edit by JJRN on Apr 12, '06