DNR pet peeve

[Vespertinas]

I am so annoyed with doctors and nurses who don't understand the difference between DNR and palliative care!

It scares the wits out of me when I've had a patient who is DNR and the MD drags his feet to treat a patient for something TOTALLY treatable. An example is a patient spiking fevers and incr WBCs (admitting dx completely nothing to do with it) and the MD doesn't think it's worth investigating a source of infection and just treating it!!

Or an RN who exclaims "she doesn't need to be on telemetry then!" when I give report that a DNR patient is on cardiac monitoring. We had a healthy argument where he insisted that he shouldn't waste his time observing heart rhythms if the patient is DNR. Meanwhile the patient that day went into SVT (again, unrelated to admitting dx) and we converted it and went on with our day. Why SHOULDN'T you fix what's fixable??

DNR does not mean withdraw care! A family made a painstaking decision to not resuscitate their relative in THE EVENT that it could be required. They TRUSTED us with this delicate situation and in return we are distorting their intentions into something that is more akin to just neglecting their loved one altogether!

Really makes me think twice about a DNR order for MY family.

[tothepointeLVN, LVN]

Agree with CapeCodMermaid. If someone is in the actively dying category Minutes to Hours, Days to Weeks then certain things go on the backburner especially as the pt starts to have ALOC and administration of PO meds become difficult. If the patient wants to take it I'll give it but often it's the family thats more insistant that "grandma" needs this this and this.

[Vespertinas]

I didn't take anything out of context. You only added "if they die in a few days" after I questioned your original statement. I appreciate your clarification, though.

A 96 year old should not have to suffer hypothyroidism if she can take a once daily pill to fix it. Nor should she risk rupture of an unstable plaque any earlier than necessary. Nor should we let something as simple as low vitamin D level spiral into hyperparathyroidism and subsequent osteomalacia, especially in the setting of renal failure.

We also shouldn't be withdrawing care on the basis of someone's age. Unless that's something the patient desires. Did I mention I have a "pet peeve"?

[tothepointeLVN, LVN]

Vespertinas. You do realize that it takes 6 weeks before any change in hypothyroidism medications take effect (up or down in doseage or discontinued) even then it would take months for it to spiral down to something troublesome.

Hospice/Palliative/End of Life care is very subtle and you should not judge anyone's judgement unless you have the patient in from of you. What may sound cruel just on paper becomes compassionate when you actually see the situation.

My eyes were opened when I started working Hospice and I don't think they can ever be closed again.

[Vespertinas]

i already said i agreed with the point where if a patient is actively dying then we have a different situation on our hands. medication management can certainly then be considered in a different light.

i want to be very clear that the original stand-alone statement said "

[color=#333333]95% of the medication people take in ltc could be considered unnecessary

" which is not the same as the discussion about end-of-life we are now having. again, i can't say this with authority but i believe that ltc

[color=#333333]

hospice.

it sounds like we're on the same page except i am careful to point out those little things that may mislead people about their ideas of geriatric care.

[tothepointeLVN, LVN]

this a discussion about dnr's so talking about end of life is more relevant than taking one single sentence by another poster and beating it to death.

"

it sounds like we're on the same page except i am careful to point out those little things that may mislead people about their ideas of geriatric care."

you admit you have a pet peeve. please state it more eloquently so you don't get into these back and forth semantics. you started a post assumably to get different opinions on the matter and you did but your just trying to rip everyones points to shreds so why bothering soliciting opinions.

[Vespertinas]

Plenty of threads get sidetracked or simultaneously discuss multiple points. There is no reason why I shouldn't respond to something I saw needed clarification.

So I can ask for people's opinions but I can't respond? I hardly even ripped anything to shreds. I asked which medications capecod thought were unnecessary and I got a response in bolded capital letters accusing me of taking something out of context.

Pointing out again that I have a "pet peeve" is somewhat of an apology if I come off as dogmatic but also as an excuse for me to pursue my point. Obviously I started the topic on this, so I find it appropriate to continue discussing the matter as different points get brought up.

To me, a message board should ideally be more for interactive discussion rather than a survey where everyone posts isolated responses.

[CapeCodMermaid, RN]

Vespertinas,I try not to take things personally on an impersonal post, but I cannot help but take offense at your inference that your idea of geriatric care is more right then mine.

I've been in the geriatric field for more than 30 years. I spend my days making sure people in my care get the care they need based on their own ideas of what they need to lead a fulfilling life, however long that life is.

After all these years of talking to the residents in my buildings, a common thread appears. Most, if not all of them, hate taking needless medications. I would be derelict in my duties if I did not try to get rid of all but the most necessary medications.

Vit D deficiency in a 96 year old is not the same as it would be in a 9 year old. Many vitamins cause nausea and other unpleasantries. I advocate for my residents based on what they want, and they do NOT want to start their days with a handful of pills.

My idea of geriatric care is to let the elder be the expert on the direction their care will take.

[Vespertinas]

Sooo we agree

I said a couple times that I find it acceptable to remove medications if it's something the resident wants.

We're two nurses with strong convictions on geriatric care butting heads with the wrong people. Obviously you care about your residents and want the best for them and I hope you see I do too! The people who we should have a problem with are those who are taking advantage of a DNR order to mean that they should do less interventions on a patient on the whole. I'm sorry but regardless of their personal convictions, that is not for them to decide. Of course, there is another side to this where some poor dying patients are over-treated and physically harassed. I see that point. At present, I am more concerned with the dangers of outright NEGLECT.

[tothepointeLVN, LVN]

To answer your original question I do believe there needs to be a new system of DNR's that covers some of the more subtle things. It is true that some healthcare providers do think that withdrawal care and DNR are the same thing. The only thing if they did implement a system that had more choices how could it be made so it could be easily understood.

Maybe soon all patients will have computerized name bands and if we try to do CPR on a DNR it'll tell "Dave I don't think you should do that."

As always our most important nursing skill is that of patient advocation. I don't want to have to jump grannies bones any more than you want to see someone die from something treatable. 2 ends same stick