MunoRN 43,593 Views
Joined Nov 18, '10 - from '.'.
MunoRN is a Critical Care.
She has '10' year(s) of experience.
Posts: 8,067 (70% Liked)
There should be some sort of process for resolving these issues at your workplace, but there's no facility I've worked at where we would honor the family members request, despite being the POA. Family members generally are not allowed to deny comfort measures to a patient, and eating is a comfort measure. It doesn't really matter that she may very well aspirate, since that is a symptom of her dementia and other underlying symptoms, and if the overall plan is not to allow the underlying conditions to run their course then aspiration would be part of that. I have seen this sort of thing get referred to an ethics committee, but in the instances I've seen they immediately respond and don't even feel the need to discuss it.
To answer your question about the rate to flush it at, no you don't have to flush it at a rate of 30 ml/hr, that's a bit silly if you're flushing something that was infusing at 100 ml/hr. Keep in mind that you're flushing the medication in ahead of the fluid being pulled from the primary bag, so generally you should flush at the same rate or slower than what the medication is safe to infuse at.
If you're concerned about your license then you should be just as concerned about holding indicated meds without any apparent rationale other than what appears to be a personal bias. I get that it often feels like you're losing some sort of personal battle every time you give a patient an opiate where there is some component of seeking involved, but it's important to keep that separate from an objective assessment of whether or not the medication should be held, particularly in a post-surgical patient.
It would be reasonable given that list to ask that it be condensed to a single long acting and prn order in addition to the toradol. but the doses are all relative and can't really be compared to every other patient, it's quite possible that giving a Norco or two to another patient is far more risky than giving an opiate tolerant patient 4mg of dilaudid.
If there is no primary infusion and I'm going to disconnect it when the intermittent infusion is complete then I just program the volume to be infused at 20-30ml more than the volume of the bag, this will account for some overfill of the bag and still flush the line of the intermittent infusion so that the patient receives the entire dose.
According the article, Dr. Shewmon is claiming Jahi is not brain dead, although it also states Jahi has not yet undergone any of the tests that define brain death (not since her previous brain death declaration).
You're free to refuse to be involved in his care, but your employer is free to fire you for refusing.
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