dnr in geriatrics

Donnagg123 · Jul 13, 2008

I can see both sides of the issue. I have seen people end stage brain cancer and the family still refuse him to be a DNR. Another example was a woman who before her stroke was lively and would look at people who are just laying around like lumps and shake her head and say she would never want to be in that shape. Well. lo and behold, she had a massive stroke that basically left her paralyzed and she was unable to speak or move. Instead of letting her pass, her sister decided to put a g-tube in as she was the POA. You can see it in her eyes she is alert and able to understand what you say and she moans out and cries a lot. All she does is lay there like 3rd base. I know that is not what she would have wanted as she has 0 quality of life.

On the other hand , several times I have called MD's about a resident and the first thing they ask is what is their code status? Hello! They have pneumonia/flu (or whatever). Something that could be treated with ATB or maybe they just need a breathing tx or two. If they are terminal I could see that but sometimes MD's cause part of the problem too by just brushing them off ("well they ARE 80 or 83" etc.). I think it is about quality of life. If the person no longer has a potential to have any quality of life why let them linger and suffer?

JeanineLPN1984 · Jul 16, 2008

In all my years in LTC, I've seen this many times. Denial does play a big part but guilt is worse. I have found that nobody wants to be responsible for " mom " dying. Even when they understand there is no hope, they don't want to sign the papers, especially if this was never discussed beforehand with the patient.

They ask " What would you do" and still they have difficulty with the decision. In most cases the family really knows what to do, it's the guilt that they will be blamed by other family members for making that hard decision.

I had a 49 y.o man who had a brain aneuyrsm and no advanced directives, I also had 2 sons that had different ideas of how dad should be treated. His v/s were unstable, he had cardiac arrythmias and he never gained consciousness. The MD spoke to them and the one son said to the brother " I want everything done and if you sign that paper and dad dies, it's your fault" Well the DNR did'nt get signed and a bit later we had a full out code going. He died at the hospital a few hours later, but what a shame he went through.

A few months ago we had a lady who was a DNR, her son was visiting and walking with her in the hall and she collapsed and coded. He started yelling " Do something, save her" Her DNR was overridden and CPR was started, but she died and EMS couldn't save her. But the son saw everything going on and later said, " It was horrible, I did'nt want to see her like that" ( meaning the code).

We as nurses see these things and it is so important to make your wishes known to your family, doctor and friends. Then if they need arises, no one in your family will feel guilty about signing those papers if you haven't.:wink2:

JeanineLPN1984 · Jul 16, 2008

By the way, Eldragon how's it going? Are you still at the same place? I am and were gearing up for survey. Take care.

hippylady7211 · Jul 16, 2008

:nurse:Maybe it is just me but. . .As I was growing up our family discussed what we wanted done if. . .so when the time came we all knew what to do.

I have been a practicing RN since 1982 and since that time I have seen a lot of advances in end of life nursing. It used to be no one wanted to work with the dying and talking about end of life decisions was a no no. We are so lucky (and our patient's too) that as nurses we can do patient/family education around end of life issues. Be frank, but also be aware that this is one of the most important/possibly guilt ridden decisions that a family needs to make. Talk them through the process and be prepared for decision changes.

Have you talked with your family about what you want done? End of life decisions are/can be one of the most beautiful and frustrating parts of nursing. :heartbeat One of the worst parts of following my families wishes was overhearing a nurse talk about how we were "killing" our family member by not allowing feeding tubes. What a horrible judgement to place on a family. Remember if the family decides on a DNR or not keep your opinion to yourself. It is not your decision it is theirs.

DNR's in geriatric, absolutely! But as nurses it is our place to educate, encourage and provide excellent care no matter what the decision.

Had a daughter that just could not let her mother go. But when the time came, daughter wasn't there but I was. I held this womens hand and we said the Lord's Prayer together and she died. Sometimes families just can't "do it" but I was able to help this little lady be in peace and what a gift I received.

Thanks for letting me get on my soap box. Hope I didn't offend and it was not meant to. Just meant to remind that we as nurses hold so much power in informing the family of the dying process, how to keep people comfortable, the beauty of the dying process and how to encourage families and patients through it. We also have the power to care for those patients that do not have the DNR in place and give them the best, respectful and dignified care that they deserve until the end has come for their jouney.