Comfort measures only ???

meownsmile, BSN, RN · Jul 19, 2006

I guess its possible that he is thinking the patient may be overloading if he is in renal failure and that the glucose level isnt actually a correct reading. Did he order another glucose after lasix or is he due one at the next meal? You didnt really say how much output he is having or what his blood pressure is running, that can make a big difference.

But no,, comfort measures does not mean do not treat. Ive had patients go on cardizem gtts for blood pressure that were comfort measures only. Most of our docs look at it as no heroics (no code, no vents but it still means you treat symptoms).

Antikigirl, ASN, RN · Jul 19, 2006

This is why I hate orders for comfort measures only! There needs to be specific PRN orders for such cases! We in Oregon have a POLST (Physicians Orders for Life Sustaining Treatment) that has listing under the comfort measures only that pts check off what they want...say they don't want IV, but if helpful they wish antibiotic treatment PO. If they wish to continue routine treatments such as insulin...and so on!

The doc gets that call though...and document that FULLY! You never know, perhaps the doctor has a very valid reason for their choice, and may know something via a convo from the pt that you may not.

IT can be sad I know...been there many times. IF you feel too uncomfortable at your present job, don't waste your energy in misery...use that to find another job so you can perform your special tallents for folks in a better environment.

Good luck!

TazziRN, RN · Jul 19, 2006

You treat symptoms for comfort but do nothing to prolong life.

ICURN_NC · Jul 19, 2006

In our unit, someone who was comfort care only wouldn't have even had an accu check done, anyway. Of course, most of our pts are made "comfort care" and then extubated and/or pressors are turned off, etc. So they may only live a few minutes or hours.

On comfort care they would have MIVF going and usually a morphine ggt.

weirdRN, RN · Jul 19, 2006

This is a really good question. I have two patients on the same floor in similar conditions. The one lady has IVF running @50 per hour and just wants to die peacefully. #1 has plus 2 pitting pedal edema, refuses all food and drink, and asks for pain meds everytime we are able to give them. She might have had a good chance of recovering. The second lady does not want to die but will not take fluids or attempt to eat. #2 is so dehydrated that we can't get an IV in her. She has an infected rt hip surgical wound, and was in generally poor health before she came to us. Her case was bad and looks worse every day.

#1 is comfort measures only. #2 is a full code.

Altra, BSN, RN · Jul 19, 2006

At your facility, what does "comfort measures only" mean?

At my facility, there is a code status sheet attached to the chart which the physician has completed with the patient & family, indicating exactly which interventions are to be done and which are not; i.e., IVF, abx, intubation, other respiratory interventions, CPR, etc.

Look through that patient's chart -- see what documentation is there. And then document the heck out of the situation in your nurses notes: "MD aware of glucose reading" etc.

I guess I'm saying, there is (or should be) no guessing on what "comfort measures" means ... there's either documentation to specifically spell it out or there isn't. If there's no code status sheet indicating that certain expected interventions are not to be done, per the patient/family's wishes, then I would be questioning the MD, documenting the entire conversation just about word for word, and taking it up the chain of command if necessary.

CardioTrans, BSN, RN · Jul 19, 2006

We have several different "code status" DNR, DNI, full support DNR/DNI, comfort care only, or full code.

With a full support DNR/DNI, we only "chemically code" the patient. Drugs only, no chest compressions, no cardioversion, no intubation. But we do give drugs for BP, to treat low lab values etc.

Comfort care only, nothing is done. They move to the floor or the palliative care unit. No frequent labs, nothing. Just kept comfortable with pain meds.

Our policy lists specifically what is done with each status. The MD puts in the order, and it spells it out.

suzanne4, RN · Jul 19, 2006

Comfort Care Only, means just that. Comfort for the patient.

Treating with pressors and on drips for blood pressure is not comfort care, that is a paitent that just has a DNR order. Meaning no compressions, no reintubation if extubated, set.

For comfort care, the patient is usually terminally weaned from the vent, if they are on one, and only given meds to keep them comfortable. No lab draws, no glucose checks, etc. IV may or may not be used. Water may or may not be given.

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If labs are being drawn or checked, then that is not Comfort Care.

Antikigirl, ASN, RN · Jul 19, 2006

Again, I really think comfort measures should have clear orders for what to tx and not. What is comfort to some is an intervention of life saving quaility to another. Especially when it comes to family members!

I saw this so often in AFL when a pt came home from the hospital from being tx for a raging UTI and dehydration and they were on COMFORT measures only! They had IV hydration in them and that prolonged end of life quite a bit. However, is hydration a comfort measure??? To some certainly...to others not and prolongs end of life. So many times it was unclear till they got to my facility and we stopped hydration. Sad thing is...it made most of my patients go from 2-3 days to a week or more just by a day of IV hydration. I bet that wasn't too comfortable!

Or oxygen...some people see it as the life saving med it is...other see it as prolonging life. Hypoxia is not comfortable, however it is a part of death...which do you choose (most of us will oxygenate anyway in my area).

I even had one nurse not give morphine because it opens up the heart and lung blood vessels prolonging life! But what about comfort???

The list can go on and on. If a person with Comfort only falls...should you have that looked at or just leave it be? If they have a UTI...do you treat to the point of IV antibiotics to stop the discomfort when a UTI isn't the main reason for end of life?

Where do you draw the line?

That is why I am so thankful that at the ALF I worked for it was clearly written as to what we could do and not do, and hospice was called in to assist! If not we had the MD write very specific orders including many sceneros that may arrise (like my pt that rolled out of bed, and yes we did have her treated in the ED because she broke her arm).

leslie :-D · Jul 19, 2006

i have never seen a consistent translation of cmo.

when i worked inpt care facility in hospice, we gave abx for uti, pneumonia, w/the rationale that the infection was a source of discomfort.

but there are hospices that will not cover antibiotics.

o2 is a comfort measure.

many mds continue the important meds...dilantin, digoxin, insulin, etc.

i do recommend eliciting the feedback of ea and every pt re: their perceptions of cmo.

there isn't anything standard about it.

leslie

soliant12 · Jul 20, 2006

How is a hypoglycemic seizure comforting?