The Slow Code - page 5

I have been a nurse for only seven years; however, certain events and situations will remain embedded in my memory for the rest of my life. One of these events took place during my first year of... Read More

  1. Visit  KelRN215 profile page
    1
    This reminded me of a patient who I will never forget from a med-surg clinical in nursing school. My clinical instructor arranged for me to spend a day in the MICU. The patient was a man in his 40s or 50s with end stage multiple myeloma. He was intubated, sedated, in multi-organ system failure, with central lines, a G-tube, a foley, a rectal tube... basically any tube you can imagine, this guy had. He was a full code. In his chart, there was a living will which stated "I do not wish to be kept alive artificially. I do not want a feeding tube. I do not want CPR. I do not want to be put on a ventilator." He was a bachelor and his siblings were his next of kin. They believed that he would "want everything done." This man was dying and dying soon. CPR would not have ever saved him. I don't know what happened to him since I was only there that one day but I hope that he wasn't coded when he did die.

    I am only 28 but I have already told my family that under no circumstances would I want a feeding tube or a trach. If they were to ever disregard my wishes and insist on futile heroic measures well, then I can only hope that there's an after life so I can come back and haunt the hell out of them.
    OnlybyHisgraceRN likes this.
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  3. Visit  redhead_NURSE98! profile page
    0
    Quote from Jean Marie46514
    You are a great candidate to have a living will drawn up. (or, as it was referred to, during the Obamacare discussions, a "death panel") A living will can state ANYTHING *you* want done, for example--- do everything, no matter what!
    Or everything unless i am verifiabley brain dead for 3 days. Or whatever algorithm fits YOUR wishes. It is NOT a "death panel" as so many seem to think it is. It is only a statement of your exact wishes, in various scenarios, to relieve your family of trying to guess what you'd want done in this or that case.
    The problem I have with these is that I've seen physicians just see these documents and say "oh they're DNR." Um NO. Therefore I will not be filling one out for quite awhile.
  4. Visit  akulahawkRN profile page
    1
    I have seen the slow code... never participated in one though, and generally, I refuse to. I have also seen, and suggested heavily to families that when their relative is headed home to get called home that they seek out a DNR order because I know just how brutal and invasive running a code on someone can be. I have had to do it - even on people that I knew it would be an ultimately futile effort. Because I believe that full code people should be given their best chance, I'll do it all at full-speed, even if it'll be futile. It's not my place to judge someone else's wishes. I'm even willing to provide massive amounts of care to DNR patients because that doesn't mean "do not treat."

    Since we all will die, our job isn't so much to save lives, but rather to extend quality of life. Everyone is different, and because of that, the time that our quality of life becomes more important than the quantity of it will be different for everyone.

    I think of it like this: our job in a code is to provide someone a good shove toward life. If they're able to respond, good. If not, let them go as peacefully as possible, and comfort the family. They're the patient too.
    Sadala likes this.
  5. Visit  Indy B profile page
    3
    It seems that a lot of discussion revolves around the family's wishes. One of the most interesting questions I heard while interviewing was, "Do you think family should be present for a code?" My answer was a resounding "YES!" Education is key, if family knew what truly went into a full code, they might not brush off the DNR so quickly. I can't support NurseCard's statement enough, DNR is NOT Do Not Treat.
  6. Visit  MusicEMT profile page
    0
    Quote from BrandonLPN
    What about the nurse who comes across the full code pt in LTC who's clearly been dead for a couple hours? Is it "unethical" to forgo a code in that case? I mean, come on people, at some point all we're doing is desecrating a dead body.
    In EMS if they are clearly dead the paramedics can call them on the spot (ie Rigor mortis or decapitation or whatevs)
    there is a saying in EMS: they are not dead till they are cold and dead

    i dont know how it is in LTC.. i would assume if they are clearly dead (cold and dead for a few hours) you dont need to start code measures?
  7. Visit  subee profile page
    2
    Quote from RFarleyRN
    Well I hope you are my nurse when I am old and cannot make decisions for myself. As an RN, and former hospice nurse, I am so apalled by this, I can hardly speak!! This man had the right as a patient to have every effort initiated to save his life. We are not to play God with anyone elses life. I would hate to stand before the Lord and face judgement for actions such as your co-workers. Horrible situation.
    I disagree. The fact is that only 15% of inpatient codes survive. The original OP described a situation of a patient so frail that the ribs were crushed during the codes. EVERY patient's situation is different and deserves a decision based on our intellectual and compassion skills.
    KelRN215 and somenurse like this.
  8. Visit  Esme12 profile page
    3
    Quote from redhead_NURSE98!
    The problem I have with these is that I've seen physicians just see these documents and say "oh they're DNR." Um NO. Therefore I will not be filling one out for quite awhile.
    I have always HATED this attitude DNR does NOT mean do not treat. I had a personal experience with this recently with my brother in law and being transferred to ICU when hospitalized when the ICU nurses had the unmitigated gall to talk to my sister about her husband "taking up an ICU bed". Just because we didn't want him coded doesn't mean we didn't want treatment to stop the immediate threat or that he should suffer because a DNR in ICU takes up valuable space. My BIL was YOUNG....I was so angry it made me want to spit nails.

    Even a DNR can require care befitting an ICU and you know what....sometimes a family just isn't ready to say good bye.

    But this is off topic...sorry
    monkeybug, noyesno, and Silverlight2010 like this.
  9. Visit  PMFB-RN profile page
    2
    Quote from KelRN215
    I am only 28 but I have already told my family that under no circumstances would I want a feeding tube or a trach. If they were to ever disregard my wishes and insist on futile heroic measures well, then I can only hope that there's an after life so I can come back and haunt the hell out of them.
    *** Seems very premature to me. I regularly see young trauma patients who get both a feeding tube and a trach who go on to lead totaly normal and high qualiety lives with nothing but a few scars to show for their experiences.
    GrnTea and hiddencatRN like this.
  10. Visit  PMFB-RN profile page
    4
    Quote from Esme12
    I have always HATED this attitude DNR does NOT mean do not treat. I had a personal experience with this recently with my brother in law and being transferred to ICU when hospitalized when the ICU nurses had the unmitigated gall to talk to my sister about her husband "taking up an ICU bed". Just because we didn't want him coded doesn't mean we didn't want treatment to stop the immediate threat or that he should suffer because a DNR in ICU takes up valuable space. My BIL was YOUNG....I was so angry it made me want to spit nails.
    Ya totaly don't blame you. It was an improper and terrable thing for that nurse to say. WHen I speak to patients about DNR status I frame it as "what do you want us to do after you die?" So long as a patient is alive the DNR isn't in effect and should not be taken into account when providing care.
    Esme12, somenurse, redhead_NURSE98!, and 1 other like this.
  11. Visit  akulahawkRN profile page
    3
    Quote from PMFB-RN
    Ya totaly don't blame you. It was an improper and terrable thing for that nurse to say. WHen I speak to patients about DNR status I frame it as "what do you want us to do after you die?" So long as a patient is alive the DNR isn't in effect and should not be taken into account when providing care.
    The DNR is in effect until it is rescinded... I look at it as a very specific restriction on what therapies I may not use. Unfortunately, the do not treat attitude is all too common, especially if the patient is elderly.
  12. Visit  joanna73 profile page
    1
    I know of the "slow code", as I work LTC. I have never participated in one myself, but we have discussed this at work. I would rather honour the wishes of the patient/family. Their code status is documented, and 95 percent of our residents are DNR anyway. The family/ patient should always be given their options and consent to the treatment plan. At times, we have recommended that a resident's code status be changed to DNR, as reviving that person would ultimately cause more suffering, and this has happened.
    somenurse likes this.
  13. Visit  PMFB-RN profile page
    0
    The DNR is in effect until it is rescinded...
    *** The DNR order is irrelevent until the person dies. We don't code people who are alive, at least I don't.

    I
    look at it as a very specific restriction on what therapies I may not use.

    *** What therapies are resricted when a patient is DNR? None I am aware of, with the possible exception of intubation, (depending on if you are in a DNR vs DNR/DNI faciliety) until after they die.


    Unfortunately, the do not treat attitude is all too common, especially if the patient is elderly.
    *** Yes I agree, however I see this as a symptom of the much broader problem of a society with unrealistic expecations combined with denial of realiety.
  14. Visit  turnforthenurseRN profile page
    0
    I have never heard of this before but it is very disturbing.

    Meanwhile, nurses are once again the most trusted profession for 13 years in a row....


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