DNR orders - page 4

After having once again witnessed a doctor ask a patient (this time a 91 YO) "if your heart stopped would you want us to do anything?" and then write orders for a full code without any further explanation to the pt of what this... Read More

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    I personally think it's selfish. In the 104 year old man's case he probably died ages ago mentally. He was just a shell of a man. When I looked into his green eyes, they never looked back, and he wasn't suffering any kind of blindness. There was no person left.

    I cry about that poor patient. I hope nobody ever does that to ME...
    leemacaz likes this.

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    Quote from TiredMD
    Usually we very politely and respectfully appologize to the patient, explaining that it was an error.

    Then we . . . you know . . . kill them.

    OK... so now you have appologized to me... are you also gonna explain to me just how you are going to kill me? Just how are you going to do it?
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    When I'm that old and my ribs are brittle enough to snap or if I have a terminal ilness, I would like to be a DNR. The unfortunate thing is, there are medical professionals that think it means "do not treat".

    There is also the flip side, where sometimes the Dr. will overrule the DNR for whatever reason, even if it is against the pts. best interest. And they suffer for it, because the Dr. just can't let go.
    leemacaz likes this.
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    I just had dinner with a cardiolgist friend of mine who told me the survival rate for MIs in emerg is about 10% and even less after they've been on the floor awhile. I just ran a code tonight on a 99 yr old woman with CHF. What do you think happened?????? I don't get it??????? MRPs need to be more forthcoming in explanations of care and care expectaions, especially with the sevre senior crowd. Not like the don't deserve the chance. But throwing a 99 yr old on the floor and cracking their ribs for CPR to lose them within 12 hrs.........lets think about dignity and quality. Im sure the family wouldnt have wanted it if they new the truth
    tewdles, med/oncRN, and leemacaz like this.
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    When I get a patient, I always discuss code status. It is very easy to bring up especially upon admission when you screen for advance directives. I then inquire exactly how much resuscitation they want and explain what CPR REALLY is, not what you see on TV. Most people don't realize how much damage CPR does especially to an elderly person who we are resuscitating to prolong the inevitable. If I have a patient who is going downhill I will broach the subject with the family. Yes, it is difficult and uncomfortable and often times the doctors wont bring it up. If you think about it a lot of MD's don't want to ever give up. They are taught to treat and conquer it goes against their training. Many times when it is brought up and the patient/family has a real understanding of what happens during a code they don't want it done. I have had elderly people tell me "hell no, don't do that to me." I'm talking about very elderly patients, or those that are terminally ill on their last legs. I have no problem running a code when it is appropriate. I don't want to sound like I am inhumane, but really coding a 98 year old is cruel. I have had doc's come up during a code and take a look at patients who have no chance and say "you have got to be kidding me, why are we doing this?" Why, because the doctors don't do their jobs to begin with. Yes people do have the right to be coded when they are 98 if they have been informed and this is what they desire, but often times it is really not what they or their family would want.
    squeakykitty likes this.
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    Quote from leemacaz
    OK... so now you have appologized to me... are you also gonna explain to me just how you are going to kill me? Just how are you going to do it?
    It'll most likely be a complication of the humor transplant you so desperately needed.
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    I actually have seen one md who had the balls to tell a patient who was circling the drain that we could absolutely do nothing more for him other than to keep him comfortable. The patient wanted to be a full code, but the doctor wrote DNR. The ethics board reviewed it and sided with the doctor. The patient died two days later. I also was at an oncology seminar and an md speaker stated that a doctor if they were brave enough can write a DNR if coding a patient is futile. We just rarely see it. Any thoughts on this. Also, at our facility even if you have a DNR on file, the doctor still has to write the order. Just because it was effective on a previous admit it still has to be readdressed and written by and] MD. Check old records and be an advocate for your patients, their wishes are often overlooked.
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    Had a patient once, a few years ago, that was in her 40's. She was a cancer patient and was hit hard and fast by it. She wanted to be a full code and so we full coded her. It really didn't make much of a difference. Maybe a day, it gave her another day of laying there swollen with edema, seeping with fluid,, unconscious, on a vent, stiff as a board because she was so swollen. She didn't even look like the same woman that came into the ICU two weeks earlier. She got another day of that, and her family got another day of looking at her like that.
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    Quote from Nurse4years
    "I have been here before- they have it on file".
    My response to the above is always the same: "Yes, I understand that. But I still need to see your copy - for a couple of reasons. One, to make sure that our copy matches yours. Second, to incorporate any changes you might have made. Lastly, for legal purposes, I need to have a current copy on file for record. I want to avoid any errors, that's all".

    I use the same spiel for "medication/allergy lists" as well.

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    POLSTs are great, I wish more people were educated about them. Patients wishes are spelled out simple and dont require pt or family signing and dr signing for each hospital visit.

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