Why Continue Accuchecks on 92-Year-Old Comatose Patient...

Specialties MICU

Published

Specializes in ICU, CM, Geriatrics, Management.

Who suffered a massive stroke (per CT scan), there is no electrical activity to the right side of the brain (per EEG), and left carotid is totally occluded?

What is the purpose of insulin and dextrose treatments in this case?

Family has requested comfort care only.

Thanks in advance.

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if the family has stated "comfort care only" then you shouldn't cont accuchecks, labs, antibiotics, ect. sometimes if the patient has been on oxygen,i will cont it.(more for the family, for some reason it seems to make them feel better) otherwise, i only give morphine (or painmed) and ativan (if ordered) prn. i would clerify with md regarding orders and if he told you to cont accuchecks, i would remind him of the families wishes. if he insisted, i would go up the chain of command. also you could ask the family if they wish to cont. them (if md still wants them). usually, they will say no.

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Specifically ask the doc if he wants them. Sometimes our docs forget exactly what all the orders are, especially if it is a patient we have had for awhile who has deteriorated.

I'd just ask the doc.

steph

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:o Is this 92 year old on Medicare? I have heard that Medicare pays well so perhaps the doc wants to do everything to keep him alive?
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Specializes in Oncology/Haemetology/HIV.
:o Is this 92 year old on Medicare? I have heard that Medicare pays well so perhaps the doc wants to do everything to keep him alive?

Depending on the state....as a general rule, Medicare doesn't pay jack. In Georgia for example, MDs are trying to limit Medicare/Medicaid, as the reimbursement is lousy and delayed by 9-18 monthes.

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Specializes in ICU, CM, Geriatrics, Management.

You folks are fab! Thanks again for the lightning responses.

Person involved is on Medicare.

Treating facility is in FL.

Will follow through with the family.

Quick follow-up: Ativan and morphine have been ordered PRN. When are they administered? (When patient appears agitated? Twitches?)

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do a search for pain management and you will find some tools on how to measure pain in non-verbal patients. Try the oncology sites. One tool is called the PAINAD scale and measures breathing, vocalization, facial expression, body language and consolabiltiy on a 1-3 scale. It is found in the August issue of Nursing2004 (an article by Patricia Lane called Assessing pain in patients with advanced dementia). http://www.nursing2004.com

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Specializes in CCU/CVU/ICU.
You folks are fab! Thanks again for the lightning responses.

Person involved is on Medicare.

Treating facility is in FL.

Will follow through with the family.

Quick follow-up: Ativan and morphine have been ordered PRN. When are they administered? (When patient appears agitated? Twitches?)

If the patient has has a cva, he/she is at risk for developing seizures. Ativan can control these.

Sometimes, if the pt is in a vegitative(sp?) state and is expected to die, administering MS is more to treat the family than the patient....if you follow what i'm saying...regardless if the patient is saying ouch..

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Specializes in ICU, CM, Geriatrics, Management.

Another follow-up:

Forgot to mention the patient has a pacemaker. How will that affect how long she'll remain in her present state?

Thanks.

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Regarding accuchecks/insulin/dextrose.....

Blood sugars that are too low or too high can cause a patient discomfort, so perhaps your doctor feels this is a comfort care measure.

Regarding the pacemaker....

It certainly offers the heart some benefit since it will continue to provide the heart with electricity, but as the heart continues to become deprived of oxygen, it will eventually infarct in an area of conduction and your patient will either go into a lethal arrythmia or asystole..... however, the pacemaker will continue to try and pace the heart even after death, so your death strip likely won't show asystole, but will have some electrical beats.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Trauma Queen, your AVATAR!! LOL!!!!!!!!!!!!!!!!!!!

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Depending on the state....as a general rule, Medicare doesn't pay jack. In Georgia for example, MDs are trying to limit Medicare/Medicaid, as the reimbursement is lousy and delayed by 9-18 monthes.

:chuckle At the LTC I work at they offer the "Medicare" patients private rooms and it seems the business office likes these medicare patients. However, if a patient is on medicaid then they are not treated as "special"

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